1598717316 NPI number — PRISMA HEALTH-MIDLANDS

Table of content: (NPI 1598717316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598717316 NPI number — PRISMA HEALTH-MIDLANDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRISMA HEALTH-MIDLANDS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1598717316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
300 E MCBEE AVE FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29601-2842
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-296-2254
Provider Business Mailing Address Fax Number:
803-296-2540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1330 TAYLOR AT MARION STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLUMBIA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29201-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-296-2243
Provider Business Practice Location Address Fax Number:
803-296-2540
Provider Enumeration Date:
05/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
POLLY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
VP PAYOR STRATEGIES
Authorized Official Telephone Number:
864-522-2286

Provider Taxonomy Codes

  • Taxonomy code: 273R00000X , with the licence number:  HTL739 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 004200187 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 909225100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 412442 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200452330A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: SC1968 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 003035854 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 101066707 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 418962 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0100452000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 400863 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4200018 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com