Healthcare Provider Details

I. General information

NPI: 1376175000
Provider Name (Legal Business Name): CAROLINA PAIN SOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2020
Last Update Date: 05/11/2021
Certification Date: 05/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 SUMMIT TERRACE CT STE 1B
COLUMBIA SC
29229-7056
US

IV. Provider business mailing address

1494 LAKE MURRAY BLVD
COLUMBIA SC
29212-8697
US

V. Phone/Fax

Practice location:
  • Phone: 803-597-2874
  • Fax: 803-597-2934
Mailing address:
  • Phone: 803-764-0464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: AMBER COMPTON
Title or Position: PRACTICE MANAGER
Credential:
Phone: 803-764-0464