Healthcare Provider Details

I. General information

NPI: 1629460381
Provider Name (Legal Business Name): ATLANTIC COAST PAIN SPECIALISTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 04/20/2022
Certification Date: 04/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2767 CULTRA RD
CONWAY SC
29526-3716
US

IV. Provider business mailing address

2767 CULTRA RD
CONWAY SC
29526-3716
US

V. Phone/Fax

Practice location:
  • Phone: 843-438-8470
  • Fax: 843-438-8480
Mailing address:
  • Phone: 843-438-8470
  • Fax: 843-438-8480

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number20364
License Number StateSC
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: RICHARD BLAKE KLINE
Title or Position: OWNER
Credential: MD
Phone: 843-438-8470