Provider Demographics
NPI:1912198524
Name:MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA
Entity Type:Organization
Organization Name:MIDLANDS ORTHOPAEDICS AND NEUROSURGERY, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANN MARGARET
Authorized Official - Middle Name:
Authorized Official - Last Name:MCCRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-256-4107
Mailing Address - Street 1:1910 BLANDING STREET
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29201
Mailing Address - Country:US
Mailing Address - Phone:803-256-4107
Mailing Address - Fax:803-254-2825
Practice Address - Street 1:1910 BLANDING STREET
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29201
Practice Address - Country:US
Practice Address - Phone:803-256-4107
Practice Address - Fax:803-933-6337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-08
Last Update Date:2017-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0266040001OtherNSC