Organization
MIDLANDS PHYSICAL MEDICINE, LLC
Active
Parent organization
MIDLANDS PHYSICAL MEDICINE, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
MIDLANDS PHYSICAL MEDICINE, LLC
Authorized official
DR. KELVIN J. WILEY MD (MEDICAL DIRECTOR)
(803) 419-8700
Entity
Organization
Contact information
Practice address
4531 HARD SCRABBLE RD, COLUMBIA, SC 29229-8561
(803) 419-8700
Mailing address
2980 N BEVERLY GLEN CIR, SUITE 301, LOS ANGELES, CA 90077-1726
(310) 474-9809
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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