Healthcare Provider Details

I. General information

NPI: 1003327792
Provider Name (Legal Business Name): PRISMA HEALTH-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 RICHLAND MEDICAL PARK DR
COLUMBIA SC
29203-6863
US

IV. Provider business mailing address

PO BOX 744244
ATLANTA GA
30374-4244
US

V. Phone/Fax

Practice location:
  • Phone: 803-296-2548
  • Fax: 803-296-7950
Mailing address:
  • Phone: 803-454-2600
  • Fax: 803-765-1732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateSC

VIII. Authorized Official

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