# PRISMA HEALTH MEDICAL GROUP-MIDLANDS

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- **Entity:** Organization
- **Status:** Active
- **Other names:** PH Medical Group Midlands
- **Organization subpart:** No

## Provider details

- **NPI number:** 1275988321
- **Authorized official:** KRISTI LAWRENCE (DIRECTOR-PROVIDER ENROLLMENT)
- **Authorized official phone:** (864) 522-8611

## Contact information

- **Practice address:** 3555 HARDEN STREET EXT STE 300, COLUMBIA, SC 29203-6894
- **Practice address phone:** (803) 545-5000
- **Mailing address:** PO BOX 743904, ATLANTA, GA 30374-3904
- **Mailing address phone:** (803) 296-7033
- **Mailing address fax:** (803) 296-5928

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | SC | — |
| 152W00000X | Optometrist | — | SC | — |
| 207P00000X | Emergency Medicine Physician | — | SC | — |
| 207Q00000X | Family Medicine Physician | — | SC | — |
| 207R00000X | Internal Medicine Physician | — | SC | — |
| 207V00000X | Obstetrics & Gynecology Physician | — | SC | — |
| 207W00000X | Ophthalmology Physician | — | SC | — |
| 207X00000X | Orthopaedic Surgery Physician | — | SC | — |
| 208000000X | Pediatrics Physician | — | SC | — |
| 2084N0400X | Neurology Physician | — | SC | — |
| 2084P0800X | Psychiatry Physician | — | SC | — |
| 208600000X | Surgery Physician | — | SC | — |
| 208800000X | Urology Physician | — | SC | — |
| 208VP0000X | Pain Medicine Physician | — | SC | — |
| 261QM1300X | Multi-Specialty Clinic/Center | 160413-0189 | SC | Yes |

## Other

- **Enumeration date:** 04/26/2016
- **Last updated:** 05/05/2021