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General NPI Number Information
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NPI Number | 1649478108
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Entity Type | Organization
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Legal Business Name | MIDLANDS SURGICAL ASSOCIATES
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Dates
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Enumeration Date | 07/06/2007
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Last Update Date | 02/27/2015
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Provider Practice Location Address
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Address Line | 2719 MIDDLEBURG DR SUITE 206
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City | COLUMBIA
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State | SC
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Zip | 29204-2414
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Country | US
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Telephone | 803-254-0814
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Fax |
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Provider Business Mailing Address
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Address Line | 2719 MIDDLEBURG DR SUITE 206
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City | COLUMBIA
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State | SC
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Zip | 29204-2414
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Country | US
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Telephone | 803-254-0814
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | NOHEMI POYNER
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Credential |
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Telephone | 803-254-0814
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 78011
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License Number State | SC
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