Healthcare Provider Details

I. General information

NPI: 1043540222
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: 01/11/2010
Last Update Date: 01/10/2020
Certification Date: 01/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 ENTERPRISE BLVD STE 201
GREENVILLE SC
29615-3554
US

IV. Provider business mailing address

PO BOX 6130
SPARTANBURG SC
29304-6130
US

V. Phone/Fax

Practice location:
  • Phone: 864-295-9609
  • Fax: 864-295-2337
Mailing address:
  • Phone: 864-583-0053
  • Fax: 864-583-0390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number184375
License Number StateSC

VIII. Authorized Official

Name: Y EUGENE MIRONER
Title or Position: MANAGING PARTNER
Credential: DO
Phone: 864-583-0053