Healthcare Provider Details

I. General information

NPI: 1760534358
Provider Name (Legal Business Name): SOUTHEASTERN SPINE INSTITUTE,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 03/30/2023
Certification Date: 03/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 HOSPITAL DR STE 200
MT PLEASANT SC
29464-3698
US

IV. Provider business mailing address

1625 HOSPITAL DR STE 200
MT PLEASANT SC
29464-3892
US

V. Phone/Fax

Practice location:
  • Phone: 843-849-1551
  • Fax:
Mailing address:
  • Phone: 843-849-1551
  • Fax: 843-849-6591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD F. FRISCH
Title or Position: PARTNER
Credential: MD
Phone: 843-849-1551