Provider Demographics
NPI:1679782205
Name:MIDLANDS PSYCHIATRIC SERVICE, LLC
Entity type:Organization
Organization Name:MIDLANDS PSYCHIATRIC SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:BRYAN
Authorized Official - Last Name:MOZINGO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-779-3548
Mailing Address - Street 1:125 ALPINE CIR
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6385
Mailing Address - Country:US
Mailing Address - Phone:803-779-3548
Mailing Address - Fax:803-779-7055
Practice Address - Street 1:125 ALPINE CIR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223-6385
Practice Address - Country:US
Practice Address - Phone:803-779-3548
Practice Address - Fax:803-779-7055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
Not Answered103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty