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NPI Code Detail

MEDICARE: SOUTHEASTERN SPINE INSTITUTE,LLC

MEDICARE: SOUTHEASTERN SPINE INSTITUTE,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
1207XS0117XOrthopaedic Surgery of the Spine PhysicianSC
2208100000XPhysical Medicine & Rehabilitation Physician
3208VP0014XInterventional Pain Medicine Physician
4261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1760534358
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHEASTERN SPINE INSTITUTE,LLC
Provider Business Mailing Address
First Line : 1625 HOSPITAL DR STE 200
Second Line :
City : MT PLEASANT
State : SC
Zip : 29464-3892
Country : US
Telephone Number : 843-849-1551
Fax Number : 843-849-6591
Provider Business Practice Location Address
First Line : 1625 HOSPITAL DR STE 200
Second Line :
City : MT PLEASANT
State : SC
Zip : 29464-3698
Country : US
Telephone Number : 843-849-1551
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : RICHARD F. FRISCH
Credential : MD
Telephone Number : 843-849-1551
Provider Enumeration Date : 01/17/2007
Last Update Date : 03/30/2023

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Directions to “SOUTHEASTERN SPINE INSTITUTE,LLC ” Practice Location

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