| Prisma Health Behavioral Care | |
|
720 Gracern Rd Suite 120 Columbia SC 29210-7655 | |
| (803) 296-2585 | |
| (803) 551-1254 |
| Full Name | Prisma Health Behavioral Care |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 720 Gracern Rd, Columbia, South Carolina |
| Authorized Official Name and Position | Polly H Miller (SVP FINANCE, ENTERPRISE CONTRACTING) |
| Authorized Official Contact | 8645222286 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prisma Health Behavioral Care 300 E Mcbee Ave Fl 4 Greenville SC 29601-2842 Ph: (803) 296-7305 | Prisma Health Behavioral Care 720 Gracern Rd Suite 120 Columbia SC 29210-7655 Ph: (803) 296-2585 |
| NPI Number | 1487078663 |
|---|---|
| Provider Enumeration Date | 02/10/2014 |
| Last Update Date | 11/09/2022 |
| Certification Date | 11/09/2022 |
| Medicare PECOS PAC ID | 6800708330 |
|---|---|
| Medicare Enrollment ID | O20040512000745 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1487078663 | NPI | - | NPPES |
| GP6416 | Medicaid | SC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084B0040X | Psychiatry & Neurology - Behavioral Neurology & Neuropsychiatry | (* (Not Available)) | Primary |
| Provider Name | Alexander Joseph Mcdonald |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1760598114 PECOS PAC ID: 6002885183 Enrollment ID: I20070123000098 |
| Provider Name | Rebecca Payne |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1740379817 PECOS PAC ID: 8224130828 Enrollment ID: I20070228000619 |
| Provider Name | Jennifer E Heath |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1629169214 PECOS PAC ID: 1052412855 Enrollment ID: I20070724000365 |
| Provider Name | Stephanie L Berg |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1508809831 PECOS PAC ID: 2668477415 Enrollment ID: I20090223000222 |
| Provider Name | Juliet A Glover |
|---|---|
| Provider Type | Practitioner - Geriatric Psychiatry |
| Provider Identifiers | NPI Number: 1609073014 PECOS PAC ID: 4789856105 Enrollment ID: I20111007000219 |
| Provider Name | Elizabeth Clare M Porter |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1205114808 PECOS PAC ID: 8820236383 Enrollment ID: I20151110001336 |
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