Provider Demographics
NPI:1114031564
Name:PRISMA HEALTH-MIDLANDS
Entity Type:Organization
Organization Name:PRISMA HEALTH-MIDLANDS
Other - Org Name:PRISMA HEALTH PRIVATE SERVICES
Other - Org Type:Doing Business As
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:PO BOX 7275
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-7275
Mailing Address - Country:US
Mailing Address - Phone:803-296-3100
Mailing Address - Fax:803-296-3319
Practice Address - Street 1:1400 PICKENS ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-3465
Practice Address - Country:US
Practice Address - Phone:803-296-3100
Practice Address - Fax:803-296-3319
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRISMA HEALTH-MIDLANDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-19
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMC0014Medicaid
SCEX0691Medicaid