Healthcare Provider Details

I. General information

NPI: 1861983249
Provider Name (Legal Business Name): SOUTHERN PAIN SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2018
Last Update Date: 03/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 BLARNEY DR STE 111
COLUMBIA SC
29223
US

IV. Provider business mailing address

115 BLARNEY DR STE 111
COLUMBIA SC
29223-6291
US

V. Phone/Fax

Practice location:
  • Phone: 803-419-5345
  • Fax:
Mailing address:
  • Phone: 803-419-5345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License NumberMD18268
License Number StateSC

VIII. Authorized Official

Name: DR. STEPHEN M TUEL
Title or Position: PRESIDENT / OWNER
Credential: MD
Phone: 803-419-5345