MEDICARE: TRIDENT PAIN CENTER LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WW0000X	Wound Care Registered Nurse
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	208VP0000X	Pain Medicine Physician
4	363L00000X	Nurse Practitioner
5	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician
6	208VP0014X	Interventional Pain Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	080192298	OTHER	SC	RAILROAD MEDICARE

General Provider Information

NPI Number	:	1801992961
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIDENT PAIN CENTER LLC

Provider Business Mailing Address
First Line	:	9267 MEDICAL PLAZA DR STE G
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9139
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:	843-797-3637

Provider Business Practice Location Address
First Line	:	9267 MEDICAL PLAZA DR STE G
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9139
Country	:	US
Telephone Number	:	843-797-3636
Fax Number	:	843-797-3637

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

Provider Enumeration Date	:	09/16/2006
Last Update Date	:	03/02/2026

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Directions to “TRIDENT PAIN CENTER LLC ” Practice Location

Language	Start Address	Practice Location

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