Healthcare Provider Details

I. General information

NPI: 1982129136
Provider Name (Legal Business Name): CAROLINA PAIN CARE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2017
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1112 YANCEY ST
SHELBY NC
28150-3672
US

IV. Provider business mailing address

1112 YANCEY ST
SHELBY NC
28150-3672
US

V. Phone/Fax

Practice location:
  • Phone: 704-481-7713
  • Fax: 704-481-7663
Mailing address:
  • Phone: 704-481-7713
  • Fax: 704-235-1971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number33212
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number33212
License Number StateNC

VIII. Authorized Official

Name: DR. STEVEN KENNETH BROCKMAN
Title or Position: PHYSICAN/OWNER
Credential: MD PHD
Phone: 704-481-7713