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Organization
MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA
Active
Organization
MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAREN KIMBERLY SOOTER (CREDENTIALING COORDINATOR)
(803) 256-4107
Entity
Organization
Contact information
Practice address
1013 LAKE MURRAY BLVD, IRMO, SC 29063-2824
(803) 256-4107
(803) 253-6676
Mailing address
1910 BLANDING ST, COLUMBIA, SC 29201-3520
(803) 256-4107
(803) 253-6676
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
—
—
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DME633
MEDICAID DME
SC
05
—
PA3335
—
SC
Enumeration date
03/09/2006
Last updated
01/19/2023
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