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General NPI Number Information
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NPI Number | 1043540222
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Entity Type | Organization
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Legal Business Name | CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
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Dates
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Enumeration Date | 01/11/2010
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Last Update Date | 01/10/2020
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Provider Practice Location Address
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Address Line | 10 ENTERPRISE BLVD STE 201
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City | GREENVILLE
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State | SC
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Zip | 29615-3554
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Country | US
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Telephone | 864-295-9609
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Fax | 864-295-2337
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Provider Business Mailing Address
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Address Line | PO BOX 6130
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City | SPARTANBURG
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State | SC
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Zip | 29304-6130
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Country | US
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Telephone | 864-583-0053
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Fax | 864-583-0390
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | Y EUGENE MIRONER
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Credential | DO
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Telephone | 864-583-0053
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 184375
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License Number State | SC
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