Healthcare Provider Details

I. General information

NPI: 1114031564
Provider Name (Legal Business Name): PRISMA HEALTH-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 PICKENS ST
COLUMBIA SC
29201-3465
US

IV. Provider business mailing address

PO BOX 7275
COLUMBIA SC
29202-7275
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-3100
  • Fax: 803-296-3319
Mailing address:
  • Phone: 803-296-3100
  • Fax: 803-296-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

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