Healthcare Provider Details

I. General information

NPI: 1871817437
Provider Name (Legal Business Name): LORIS ANESTHESIA AND PAIN TREATMENT, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2010
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3655 MITCHELL ST
LORIS SC
29569-2827
US

IV. Provider business mailing address

PO BOX 602437
CHARLOTTE NC
28260-2437
US

V. Phone/Fax

Practice location:
  • Phone: 843-716-7000
  • Fax:
Mailing address:
  • Phone: 800-329-9156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN HOLTZCLAW
Title or Position: OWNER
Credential:
Phone: 954-475-1300