=====================================================
General NPI Number Information
=====================================================
NPI Number | 1740163161
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRISMA HEALTH SURGERY CENTER - RICHLAND LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/31/2025
-----------------------------------------------------
Last Update Date | 10/08/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1120 ROBERTS BRANCH PKWY STE 140
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-9144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 864-797-7801
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1120 ROBERTS BRANCH PKWY STE 140
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | SC
-----------------------------------------------------
Zip | 29203-9144
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECTOR, PROVIDER 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 |
-----------------------------------------------------