Basic Information
| Provider Information | |||||||||
| NPI: | 1043771140 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MIDLANDS MEDICAL GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4531 HARD SCRABBLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292298561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034198700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4531 HARD SCRABBLE RD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292298561 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8034198700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/29/2019 | ||||||||
| LastUpdateDate: | 03/29/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCKINNEY | ||||||||
| AuthorizedOfficialFirstName: | FRANCEENE | ||||||||
| AuthorizedOfficialMiddleName: | GEDDINGS | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5136850949 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 111N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 208D00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | General Practice |
No ID Information.