Provider Demographics
NPI:1154432458
Name:PRISMA HEALTH-MIDLANDS
Entity type:Organization
Organization Name:PRISMA HEALTH-MIDLANDS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP PAYOR STRATEGIES ALIGNMENT
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:FIVE RICHLAND MEDICAL PARK
Practice Address - Street 2:
Practice Address - City:COULMBIA
Practice Address - State:SC
Practice Address - Zip Code:29203-6897
Practice Address - Country:US
Practice Address - Phone:803-296-2548
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRISMA HEALTH-MIDLANDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-31
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL741282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC232488Medicaid
20000290OtherFIRST CHOICE SELECT
SC387175Medicaid
SC232488Medicaid