Provider Demographics
NPI:1760590954
Name:PRISMA HEALTH-MIDLANDS
Entity Type:Organization
Organization Name:PRISMA HEALTH-MIDLANDS
Other - Org Name:PRISMA HEALTH HOME HEALTH
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 402121
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-2121
Mailing Address - Country:US
Mailing Address - Phone:864-454-9604
Mailing Address - Fax:
Practice Address - Street 1:1205 COLONIAL LIFE BLVD W
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-7671
Practice Address - Country:US
Practice Address - Phone:803-296-3100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PRISMA HEALTH-MIDLANDS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-28
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC148251E00000X, 251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC273557Medicaid
SC273557Medicaid