Provider Demographics
NPI:1013401561
Name:CRYSTAL COAST PAIN MANAGEMENT CENTER, PLLC
Entity Type:Organization
Organization Name:CRYSTAL COAST PAIN MANAGEMENT CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:252-636-0300
Mailing Address - Street 1:2111 NEUSE BLVD STE J
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28560-4318
Mailing Address - Country:US
Mailing Address - Phone:125-263-6030
Mailing Address - Fax:
Practice Address - Street 1:57 OFFICE PARK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:NC
Practice Address - Zip Code:28546
Practice Address - Country:US
Practice Address - Phone:252-636-0300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-19
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty