MEDICARE: PALMETTO PAIN CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	33094	SC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1205888765	OTHER		NPI
2	33094	OTHER		SPECIALTY NUMBER
3	$$$$$$$$$	OTHER		SOCIAL SECURITY NUMBER
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	21483	OTHER	SC	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1275618332
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALMETTO PAIN CENTER PA

Provider Business Mailing Address
First Line	:	41 MARSHELLEN DR
Second Line	:	SUITE A
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	843-522-3456
Fax Number	:	843-522-8263

Provider Business Practice Location Address
First Line	:	41 MARSHELLEN DR
Second Line	:	SUITE A
City	:	BEAUFORT
State	:	SC
Zip	:	29902-6900
Country	:	US
Telephone Number	:	843-522-3456
Fax Number	:	843-522-8263

Authorized Official
Title or Position	:	DIRECTOR/OWNER
Name	:	DR. KAREN M ELLER
Credential	:	M.D.
Telephone Number	:	843-522-3456

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	05/21/2020

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Directions to “PALMETTO PAIN CENTER PA ” Practice Location

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