1700133311 NPI number — PAIN SPECIALISTS OF SOUTH CAROLINA

Table of content: DR. KAREN MARJORIE KNUTH PSY.D. (NPI 1780761023)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700133311 NPI number — PAIN SPECIALISTS OF SOUTH CAROLINA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN SPECIALISTS OF SOUTH CAROLINA
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:
Provider Other Organization Name Type Code:
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:
1700133311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 CAUGHMAN FARM LN
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
LEXINGTON
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29072-7342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-832-7389
Provider Business Mailing Address Fax Number:
888-729-5727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 CAUGHMAN FARM LN
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
LEXINGTON
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29072-7342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
631-572-4414
Provider Business Practice Location Address Fax Number:
888-729-5727
Provider Enumeration Date:
08/14/2012

Additional Information

Authorized Official

Authorized Official Last Name:
SINGH
Authorized Official First Name:
AMIT
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
803-832-7389

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  32947 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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