MEDICARE: SC PAIN & SPINE 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	24751	SC

General Provider Information

NPI Number	:	1710414305
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SC PAIN & SPINE SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	4731 HIGHWAY 17
Second Line	:
City	:	MURRELLS INLET
State	:	SC
Zip	:	29576-5090
Country	:	US
Telephone Number	:	843-839-7246
Fax Number	:

Provider Business Practice Location Address
First Line	:	4112 CAROLINA COMMERCIAL DR
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29579-4223
Country	:	US
Telephone Number	:	843-839-7246
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	JASON C ROSENBERG
Credential	:	MD
Telephone Number	:	843-839-7246

Provider Enumeration Date	:	05/15/2017
Last Update Date	:	03/05/2024

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