MEDICARE: MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207T00000X	Neurological Surgery Physician
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician
3	332B00000X	Durable Medical Equipment & Medical Supplies	SC
4	207X00000X	Orthopaedic Surgery Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124096979
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA

Provider Business Mailing Address
First Line	:	1910 BLANDING ST
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29201-3520
Country	:	US
Telephone Number	:	803-256-4107
Fax Number	:	803-253-6676

Provider Business Practice Location Address
First Line	:	1013 LAKE MURRAY BLVD
Second Line	:
City	:	IRMO
State	:	SC
Zip	:	29063-2824
Country	:	US
Telephone Number	:	803-256-4107
Fax Number	:	803-253-6676

Authorized Official
Title or Position	:	CREDENTIALING COORDINATOR
Name	:	KAREN KIMBERLY SOOTER
Credential	:
Telephone Number	:	803-256-4107

Provider Enumeration Date	:	03/09/2006
Last Update Date	:	01/19/2023

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