Healthcare Provider Details

I. General information

NPI: 1427387570
Provider Name (Legal Business Name): CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 03/03/2021
Certification Date: 03/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7021 SAINT ANDREWS RD STE 1
COLUMBIA SC
29212-1177
US

IV. Provider business mailing address

PO BOX 6130
SPARTANBURG SC
29304-6130
US

V. Phone/Fax

Practice location:
  • Phone: 803-791-7175
  • Fax: 803-791-7176
Mailing address:
  • Phone: 864-583-0053
  • Fax: 864-583-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAN CASH
Title or Position: PRACTICE MANAGER
Credential:
Phone: 864-583-0053