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 104, COLUMBIA, SC 29203-6839
(803) 434-6812
(803) 434-7306
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
—
—
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7660520007
DME MEDICARE PTAN
SC
01
—
DE3875
DME MEDICAID
SC
05
—
GP8162
—
SC
Enumeration date
07/12/2017
Last updated
01/30/2023
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