Provider Demographics
NPI:1023381175
Name:SK PAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:SK PAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEMETRIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-596-3400
Mailing Address - Street 1:7780 BRIER CREEK PKWY
Mailing Address - Street 2:STE. 200
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27617-7849
Mailing Address - Country:US
Mailing Address - Phone:919-596-3400
Mailing Address - Fax:919-596-3499
Practice Address - Street 1:7780 BRIER CREEK PKWY
Practice Address - Street 2:STE. 200
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27617-7849
Practice Address - Country:US
Practice Address - Phone:919-596-3400
Practice Address - Fax:919-596-3499
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BRIER CREEK INTEGRATED PAIN & SPINE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-02-21
Last Update Date:2012-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2009-01151207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty