Organization Active NPI

Palmetto Health

Doing business as Midlands Internal Medicine

  • Internal Medicine Physician
  • Columbia, SC
National Provider Identifier
1174544886
Registry record updated Jan 22, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
Legal business name
PALMETTO HEALTH
Doing business as
Midlands Internal Medicine
Practice address
3000 NE Medical Park
Suite 108
Columbia, SC 29223-6251
Phone
(803) 462-9200
Fax
(803) 699-1474
NPI assigned
Jul 21, 2006
Last updated
Jan 22, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
PALMETTO HEALTH ALLIANCEAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jan 22, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Darrell C Coven
Title
Director, Ambulatory SVCS - Finance
Phone
(803) 296-7301

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X NU Primary

Addresses

Primary practice location

3000 NE Medical Park
Suite 108
Columbia, SC 29223-6251

Mailing address

PO Box 402145
Atlanta, GA 30384-2145
Phone (803) 296-7305

Other identifiers 2

IdentifierTypeStateIssuer
GP2081MedicaidSC
CG5471OtherSCMEDICARE RAILROAD GROUP PTAN

Other names 1

  • Midlands Internal Medicine Doing business as

National Provider Directory

National Provider Directory
Part of
Northeast Family Practi

Locations

3000 NE Medical Park
Ste 108
Columbia, SC 29223
Phone (803) 462-9200

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1264118400000",
    "number": "1174544886",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 402145",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303842145",
            "telephone_number": "803-296-7305",
            "fax_number": "803-296-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 NE MEDICAL PARK",
            "address_2": "SUITE 108",
            "city": "COLUMBIA",
            "state": "SC",
            "postal_code": "292236251",
            "telephone_number": "803-462-9200",
            "fax_number": "803-699-1474"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PALMETTO HEALTH",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "PALMETTO HEALTH ALLIANCE",
        "enumeration_date": "2006-07-21",
        "last_updated": "2010-01-22",
        "status": "A",
        "authorized_official_last_name": "COVEN",
        "authorized_official_first_name": "DARRELL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "DIRECTOR, AMBULATORY SVCS - FINANCE",
        "authorized_official_telephone_number": "803-296-7301"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GP2081",
            "state": "SC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE RAILROAD GROUP PTAN",
            "identifier": "CG5471",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Midlands Internal Medicine",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Columbia, SC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.