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

Taxonomy

Speciality
Code
Description
License number
State
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
Primary
160413-0189
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
DA9495
SC
05
GP7530
SC
Enumeration date
04/26/2016
Last updated
05/05/2021
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