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) 385-4790
Entity
Organization
Contact information
Practice address
2 MEDICAL PARK RD STE L9L10, COLUMBIA, SC 29203-6808
(803) 434-6812
(803) 434-7306
Mailing address
PO BOX 22265, BELFAST, ME 04915-4473
(803) 296-7320
(803) 296-5928
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
—
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
—
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7660520006
DME MEDICARE PTAN
SC
01
—
DE3873
DME MEDICAID
SC
05
—
GP8162
—
SC
Enumeration date
07/12/2017
Last updated
09/11/2020
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