MEDICARE: CAROLINA PAIN SPECIALISTS LLC

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	208VP0014X	Interventional Pain Medicine Physician	14490	SC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CN1741	OTHER	SC	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	4646343	OTHER	SC	AETNA
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1275727224
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAROLINA PAIN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	421 HULON LN
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4832
Country	:	US
Telephone Number	:	803-739-6628
Fax Number	:	803-739-5766

Provider Business Practice Location Address
First Line	:	421 HULON LN
Second Line	:
City	:	WEST COLUMBIA
State	:	SC
Zip	:	29169-4832
Country	:	US
Telephone Number	:	803-739-6628
Fax Number	:	803-739-5766

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	MR. ROBERT DENNIS CHAPPLE
Credential	:
Telephone Number	:	803-739-6628

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	11/27/2007

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Directions to “CAROLINA PAIN SPECIALISTS LLC ” Practice Location

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