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PRISMA HEALTH MEDICAL GROUP-MIDLANDS NPI 1295222503


NPI Information

NPI: 1295222503
Provider Name: PRISMA HEALTH MEDICAL GROUP-MIDLANDS

Doing Business As: PH ORAL & MAXILLOFACIAL SURGERY

Classification: Oral & Maxillofacial Surgery - 204E00000X
Entity Type: Organization

CLIA Number: 42D2176043

Address:
3304 FOREST DR
COLUMBIA, SC
ZIP 29204
Phone: (803) 434-6565
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PRISMA HEALTH MEDICAL GROUP-MIDLANDS is an oral maxillofacial surgery in Columbia, SC. The provider is oral and maxillofacial surgeons are trained to recognize and treat a wide spectrum of diseases, injuries and defects in the head, neck, face, jaws and the hard and soft tissues of the oral and maxillofacial region. They are also trained to administer anesthesia, and provide care in an office setting. They are trained to treat problems such as the extraction of wisdom teeth, misaligned jaws, tumors and cysts of the jaw and mouth, and to perform dental implant surgery. PRISMA HEALTH MEDICAL GROUP-MIDLANDS NPI is 1295222503. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Ph Oral & Maxillofacial Surgery.

The provider's business location address is:

3304 FOREST DR
COLUMBIA, SC
ZIP 29204-024
Phone: (803) 434-6565
Fax: (803) 434-6299

The provider's authorized official is Kristi Lawrence .
The authorized official title is Director Provider Enrollment and has the following contact phone number (864) 797-6118.

The CLIA number assigned to this NPI record is 42D2176043 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 4/23/2018 and was last updated on 2/22/2022.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.Taxonomy CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
1204E00000XOral & Maxillofacial SurgeryYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
1ZA8923MEDICAIDSOUTH CAROLINA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

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