Healthcare Provider Details

I. General information

NPI: 1518455252
Provider Name (Legal Business Name): PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2018
Last Update Date: 01/30/2023
Certification Date: 01/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 N SUMTER ST STE 200
SUMTER SC
29150-4975
US

IV. Provider business mailing address

PO BOX 743904
ATLANTA GA
30374-3904
US

V. Phone/Fax

Practice location:
  • Phone: 803-774-7621
  • Fax: 803-774-1791
Mailing address:
  • Phone: 803-296-7320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KRISTI LAWRENCE
Title or Position: DIRECTOR-PROVIDER ENROLLMENT
Credential:
Phone: 864-385-4790