1740058551 NPI number — PRISMA HEALTH AMBULATORY SURGERY CENTERS-MIDLANDS, LLC

Table of content: MS. PAULA KAYE CLEARWATER LPC (NPI 1336336601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740058551 NPI number — PRISMA HEALTH AMBULATORY SURGERY CENTERS-MIDLANDS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRISMA HEALTH AMBULATORY SURGERY CENTERS-MIDLANDS, LLC
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:
1740058551
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/19/2024
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:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
209 PATEWOOD DR STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GREENVILLE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29615-3592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-522-6700
Provider Business Practice Location Address Fax Number:
864-522-6705
Provider Enumeration Date:
12/12/2023

Additional Information

Authorized Official

Authorized Official Last Name:
MILLER
Authorized Official First Name:
POLLY
Authorized Official Middle Name:
H
Authorized Official Title or Position:
SVP-FIN, ENTERPRISE PAYOR CONTRACT
Authorized Official Telephone Number:
864-522-2286

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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