Healthcare Provider Details

I. General information

NPI: 1497128045
Provider Name (Legal Business Name): COMPASS PAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2015
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

706 ARCADIAN WAY
CHARLESTON SC
29407-7109
US

IV. Provider business mailing address

706 ARCADIAN WAY
CHARLESTON SC
29407-7109
US

V. Phone/Fax

Practice location:
  • Phone: 843-270-3723
  • Fax:
Mailing address:
  • Phone: 843-270-3723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT BLACKWELL
Title or Position: MD
Credential:
Phone: 843-414-1224