Healthcare Provider Details

I. General information

NPI: 1134544570
Provider Name (Legal Business Name): SC PAIN & SPINE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2014
Last Update Date: 03/05/2024
Certification Date: 03/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

812 FARRAR DR SUITE - B
CONWAY SC
29526-8747
US

IV. Provider business mailing address

PO BOX 4057
PAWLEYS ISLAND SC
29585-4057
US

V. Phone/Fax

Practice location:
  • Phone: 843-839-7246
  • Fax: 843-839-7323
Mailing address:
  • Phone: 843-839-7246
  • Fax: 843-839-7323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number24751
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number24751
License Number StateSC

VIII. Authorized Official

Name: DR. JASON CHARLES ROSENBERG
Title or Position: MEMBER
Credential: MD
Phone: 843-839-7246