Healthcare Provider Details

I. General information

NPI: 1154373843
Provider Name (Legal Business Name): PRISMA HEALTH-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 01/25/2023
Certification Date: 01/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

300 E MCBEE AVE FL 4
GREENVILLE SC
29601-2842
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2548
  • Fax:
Mailing address:
  • Phone: 803-296-2548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282N00000X
TaxonomyGeneral Acute Care Hospital
License NumberHTL741
License Number StateSC

VIII. Authorized Official

Name: POLLY H. MILLER
Title or Position: SVP FINANCE, ENTERPRISE CONTRACTING
Credential:
Phone: 864-522-2286