MEDICARE: DUNES PAIN RELIEF CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1235731605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNES PAIN RELIEF CENTER, LLC

Provider Business Mailing Address
First Line	:	1494 LAKE MURRAY BLVD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29212-8697
Country	:	US
Telephone Number	:	803-764-0464
Fax Number	:	803-764-3126

Provider Business Practice Location Address
First Line	:	4710 OLEANDER DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-5898
Country	:	US
Telephone Number	:	843-823-6800
Fax Number	:	843-823-6801

Authorized Official
Title or Position	:	MANAGER
Name	:	AMBER COMPTON
Credential	:
Telephone Number	:	803-764-0464

Provider Enumeration Date	:	11/11/2020
Last Update Date	:	05/11/2021

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