Healthcare Provider Details

I. General information

NPI: 1346504792
Provider Name (Legal Business Name): PAIN MANAGEMENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2012
Last Update Date: 06/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 VINECREST CT SUITE 605
GREENWOOD SC
29646-8031
US

IV. Provider business mailing address

PO BOX 484
EASLEY SC
29641-0484
US

V. Phone/Fax

Practice location:
  • Phone: 864-953-9885
  • Fax: 863-953-9883
Mailing address:
  • Phone: 864-855-1622
  • Fax: 864-855-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL A. MCCOLLUM
Title or Position: PRESIDENT
Credential: D..
Phone: 864-855-1633