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General NPI Number Information
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NPI Number | 1992226534
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Entity Type | Organization
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Legal Business Name | PRISMA HEALTH MEDICAL GROUP-MIDLANDS
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Dates
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Enumeration Date | 07/05/2017
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Last Update Date | 01/30/2023
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Provider Practice Location Address
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Address Line | 101 BUSINESS PARK BLVD FL 2
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City | COLUMBIA
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State | SC
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Zip | 29203-8401
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Country | US
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Telephone | 803-296-9200
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Fax | 803-296-6997
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Provider Business Mailing Address
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Address Line | PO BOX 743904
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City | ATLANTA
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State | GA
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Zip | 30374-3904
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Country | US
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Telephone | 803-296-7320
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Fax | 803-296-5928
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Authorized Official
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Title or Position | DIRECTOR-PROVIDER ENROLLMENT
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Name | KRISTI LAWRENCE
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Credential |
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Telephone | 864-385-4790
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207XS0106X
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Taxonomy Name | Orthopaedic Hand Surgery Physician
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License Number |
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License Number State | SC
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Taxonomy #3
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Taxonomy Code | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number |
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License Number State | SC
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Taxonomy #4
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Taxonomy Code | 207XX0004X
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Taxonomy Name | Orthopaedic Foot and Ankle Surgery Physician
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License Number |
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License Number State | SC
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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