Healthcare Provider Details

I. General information

NPI: 1376574855
Provider Name (Legal Business Name): CROWFIELD PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5790 MEMORIAL BOULEVARD
SAINT GEORGE SC
29477
US

IV. Provider business mailing address

5790 MEMORIAL BOULEVARD
SAINT GEORGE SC
29477
US

V. Phone/Fax

Practice location:
  • Phone: 843-563-4506
  • Fax: 843-563-4845
Mailing address:
  • Phone: 843-563-4506
  • Fax: 843-563-4845

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number15434
License Number StateSC

VIII. Authorized Official

Name: MRS. KIMBERLY H. FAABERG
Title or Position: OFFICE MANAGER
Credential:
Phone: 843-563-4506