Healthcare Provider Details

I. General information

NPI: 1447235106
Provider Name (Legal Business Name): MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/14/2005
Last Update Date: 03/08/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1910 BLANDING ST
COLUMBIA SC
29201-3520
US

IV. Provider business mailing address

1910 BLANDING ST
COLUMBIA SC
29201-3520
US

V. Phone/Fax

Practice location:
  • Phone: 803-256-4107
  • Fax: 803-253-6676
Mailing address:
  • Phone: 803-256-4107
  • Fax: 803-253-6676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN K SOOTER
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 803-256-4107