Organization Name: | MIDLANDS PHYSICAL MEDICINE LLC |
NPI Number: | 1356626196 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH BENJAMIN BARTON (OWNER) |
Mailing Address: | 4531 Hard Scrabble Rd Columbia |
State: | SC US |
Postal Code: | 292298561 |
Phone Number: | 8034198700 |
Fax Number: | 8038656760 |
NPI Enumeration Date: | 10/12/2011 |
NPI Last Update Date: | 11/23/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 23431 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |