Healthcare Provider Details

I. General information

NPI: 1881852598
Provider Name (Legal Business Name): PAIN MANAGEMENT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 CENTRAL PARK LN SUITE 7A
SENECA SC
29678
US

IV. Provider business mailing address

PO BOX 484
EASLEY SC
29641-0484
US

V. Phone/Fax

Practice location:
  • Phone: 864-882-6518
  • Fax: 864-882-2410
Mailing address:
  • Phone: 864-855-1633
  • Fax: 864-855-1323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. DANIEL A MCCOLLUM
Title or Position: PRESIDENT
Credential: DC
Phone: 864-343-2611