Healthcare Provider Details

I. General information

NPI: 1205889458
Provider Name (Legal Business Name): PRISMA HEALTH-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 TAYLOR ST
COLUMBIA SC
29201-2915
US

IV. Provider business mailing address

PO BOX 402141
ATLANTA GA
30384-2141
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

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