Provider Demographics
NPI:1235583576
Name:PAIN SPECIALISTS OF CHARLESTON
Entity Type:Organization
Organization Name:PAIN SPECIALISTS OF CHARLESTON
Other - Org Name:PAIN SPECIALISTS OF COLUMBIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:MARION
Authorized Official - Last Name:TAVEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-818-1181
Mailing Address - Street 1:2695 ELMS PLANTATION BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29406-7132
Mailing Address - Country:US
Mailing Address - Phone:843-818-1181
Mailing Address - Fax:843-818-1145
Practice Address - Street 1:15 MONCKTON BLVD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29206-4700
Practice Address - Country:US
Practice Address - Phone:803-252-4900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN SPECIALISTS OF CHARLESTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-04-22
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC16626174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC166262Medicaid
SCF62800Medicare UPIN