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Organization
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Active
Organization
PRISMA HEALTH MEDICAL GROUP-MIDLANDS
Active
Other names
PH Medical Group Midlands
Organization subpart
No
Provider details
NPI number
Authorized official
KRISTI LAWRENCE (DIRECTOR, PROVIDER ENROLLMENT)
(864) 522-8611
Entity
Organization
Contact information
Practice address
14 RICHLAND MEDICAL PARK DR STE 200, COLUMBIA, SC 29203-6882
(803) 296-9200
(803) 296-9297
Mailing address
300 E MCBEE AVE FL 4, GREENVILLE, SC 29601-2842
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7660520001
DME MEDICARE PTAN
SC
01
—
DE3832
DME MEDICAID
SC
05
—
GP8162
—
SC
Enumeration date
07/05/2017
Last updated
06/24/2021
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