1750304002 NPI number — CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA

Table of content: (NPI 1750304002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750304002 NPI number — CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CCAMP CAROLINA PAIN CENTER
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1750304002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPARTANBURG
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29304-6130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-583-0053
Provider Business Mailing Address Fax Number:
864-583-0390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
279 E KENNEDY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPARTANBURG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29302-1912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-583-0053
Provider Business Practice Location Address Fax Number:
864-583-0390
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASH
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
N
Authorized Official Title or Position:
PRACTICE MANAGER
Authorized Official Telephone Number:
864-583-0053

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 013KE . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 890652K , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: GP1456 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".




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