Healthcare Provider Details

I. General information

NPI: 1740398080
Provider Name (Legal Business Name): PRISMA HEALTH-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1205 COLONIAL LIFE BLVD W
COLUMBIA SC
29210-7671
US

IV. Provider business mailing address

PO BOX 402121
ATLANTA GA
30384-2121
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-3100
  • Fax:
Mailing address:
  • Phone: 803-296-3100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number056
License Number StateSC

VIII. Authorized Official

Name: POLLY H MILLER
Title or Position: VP PAYOR STRATEGIES ALIGNMENT
Credential:
Phone: 864-522-2286