=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427931955
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISMA HEALTH ENDOSCOPY CENTER - PARKRIDGE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2025
-----------------------------------------------------
Last Update Date | 07/30/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 PALMETTO HEALTH PKWY STE 100
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 803-907-7780
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 100 PALMETTO HEALTH PKWY STE 100
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29212-1754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIR-ENROLLMENT & CVO
-----------------------------------------------------
Name | KRISTI LAWRENCE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 864-522-8611
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA1903X
-----------------------------------------------------
Taxonomy Name | Ambulatory Surgical Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------