MEDICARE: PAIN CARE NETWORK 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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1467813642
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN CARE NETWORK LLC

Provider Business Mailing Address
First Line	:	9267 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9139
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9267 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406-9139
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PROVIDER
Name	:	JOSEPH NOLAN
Credential	:
Telephone Number	:	843-797-3636

Provider Enumeration Date	:	03/15/2016
Last Update Date	:	03/15/2016

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Directions to “PAIN CARE NETWORK LLC ” Practice Location

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