Provider Demographics
NPI:1588633275
Name:MIDLANDS PRIMARY CARE INC
Entity Type:Organization
Organization Name:MIDLANDS PRIMARY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MISS
Authorized Official - First Name:SANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-794-3243
Mailing Address - Street 1:3020 SUNSET BLVD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:WEST COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29169-3424
Mailing Address - Country:US
Mailing Address - Phone:803-794-3243
Mailing Address - Fax:803-794-4087
Practice Address - Street 1:3020 SUNSET BLVD
Practice Address - Street 2:SUITE 106
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3424
Practice Address - Country:US
Practice Address - Phone:803-794-3243
Practice Address - Fax:803-794-4087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC17961207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3239Medicaid
SCGP3239Medicaid