Provider Demographics
NPI:1154373843
Name:PRISMA HEALTH-MIDLANDS
Entity type:Organization
Organization Name:PRISMA HEALTH-MIDLANDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SVP FINANCE, ENTERPRISE CONTRACTING
Authorized Official - Prefix:
Authorized Official - First Name:POLLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-522-2286
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:803-296-2548
Mailing Address - Fax:
Practice Address - Street 1:5 RICHLAND MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6863
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL741282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC20000290OtherFIRST CHOICE SELECT UB
SC400186Medicaid
SC20000321OtherFIRST CHOICE SELECT 1500
SC20000290OtherFIRST CHOICE SELECT UB
SC5769Medicare PIN