Healthcare Provider Details

I. General information

NPI: 1467012021
Provider Name (Legal Business Name): PAIN SPECIALISTS OF CHARLESTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2019
Last Update Date: 08/11/2021
Certification Date: 08/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2683 ELMS PLANTATION BLVD
NORTH CHARLESTON SC
29406-7119
US

IV. Provider business mailing address

2695 ELMS PLANTATION BLVD STE A
NORTH CHARLESTON SC
29406-7132
US

V. Phone/Fax

Practice location:
  • Phone: 843-408-0386
  • Fax:
Mailing address:
  • Phone: 843-408-0386
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: EDWARD TAVEL
Title or Position: CEO/OWNER
Credential: MD
Phone: 843-408-0386