Provider Demographics
NPI:1649478108
Name:MIDLANDS SURGICAL ASSOCIATES
Entity type:Organization
Organization Name:MIDLANDS SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NOHEMI
Authorized Official - Middle Name:
Authorized Official - Last Name:POYNER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-254-0814
Mailing Address - Street 1:2719 MIDDLEBURG DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29204-2414
Mailing Address - Country:US
Mailing Address - Phone:803-254-0814
Mailing Address - Fax:
Practice Address - Street 1:2719 MIDDLEBURG DR
Practice Address - Street 2:SUITE 206
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29204-2414
Practice Address - Country:US
Practice Address - Phone:803-254-0814
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC78011208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC2044Medicare PIN