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
101 BUSINESS PARK BLVD FL 2, COLUMBIA, SC 29203-8401
(803) 296-9200
(803) 296-6997
Mailing address
PO BOX 743904, ATLANTA, GA 30374-3904
(803) 296-7320
(803) 296-5928
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
—
—
207XS0106X
Orthopaedic Hand Surgery Physician
—
SC
207XS0117X
Orthopaedic Surgery of the Spine Physician
—
SC
207XX0004X
Orthopaedic Foot and Ankle Surgery Physician
—
SC
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7660520003
DME MEDICARE PTAN
SC
01
—
DE3847
DME MEDICAID
SC
05
—
GP8162
—
SC
Enumeration date
07/05/2017
Last updated
01/30/2023
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