Healthcare Provider Details

I. General information

NPI: 1740452739
Provider Name (Legal Business Name): PRISMA HEALTH-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2008
Last Update Date: 04/14/2020
Certification Date: 04/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 CAMELLIA AVE
NEWBERRY SC
29108-3098
US

IV. Provider business mailing address

PO BOX 7275
COLUMBIA SC
29202-7275
US

V. Phone/Fax

Practice location:
  • Phone: 803-405-0808
  • Fax: 803-405-9766
Mailing address:
  • Phone: 803-296-3100
  • Fax: 803-296-3319

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251G00000X
TaxonomyCommunity Based Hospice Care Agency
License Number056
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number056
License Number StateSC

VIII. Authorized Official

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