# MIDLANDS PHYSICAL MEDICINE, LLC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** MIDLANDS PHYSICAL MEDICINE, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1457617540
- **Legal business name:** MIDLANDS PHYSICAL MEDICINE, LLC
- **Authorized official:** DR. KELVIN J. WILEY MD (MEDICAL DIRECTOR)
- **Authorized official phone:** (803) 419-8700

## Contact information

- **Practice address:** 4531 HARD SCRABBLE RD, COLUMBIA, SC 29229-8561
- **Practice address phone:** (803) 419-8700
- **Mailing address:** 2980 N BEVERLY GLEN CIR, SUITE 301, LOS ANGELES, CA 90077-1726
- **Mailing address phone:** (310) 474-9809

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 04/03/2012
- **Last updated:** 04/03/2012