Provider Demographics
NPI:1598717316
Name:PRISMA HEALTH-MIDLANDS
Entity Type:Organization
Organization Name:PRISMA HEALTH-MIDLANDS
Other - Org Name:PRISMA HEALTH BEHAVIORAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP PAYOR STRATEGIES
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:803-296-2254
Mailing Address - Fax:803-296-2540
Practice Address - Street 1:1330 TAYLOR AT MARION STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201-0000
Practice Address - Country:US
Practice Address - Phone:803-296-2243
Practice Address - Fax:803-296-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCHTL739273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA004200187Medicaid
FL909225100Medicaid
SC412442Medicaid
IN200452330AMedicaid
NJSC1968Medicaid
CT003035854Medicaid
PA101066707Medicaid
SC418962Medicaid
WV0100452000Medicaid
SC400863Medicaid
NC4200018Medicaid
SC400863Medicaid
FL909225100Medicaid