Provider Demographics
NPI:1245612035
Name:COASTAL PAIN CARE
Entity Type:Organization
Organization Name:COASTAL PAIN CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-553-3457
Mailing Address - Street 1:3203 HIGHWAY 9 E
Mailing Address - Street 2:SUITE B
Mailing Address - City:LITTLE RIVER
Mailing Address - State:SC
Mailing Address - Zip Code:29566-8143
Mailing Address - Country:US
Mailing Address - Phone:843-491-1480
Mailing Address - Fax:
Practice Address - Street 1:3203 HIGHWAY 9 E
Practice Address - Street 2:SUITE B
Practice Address - City:LITTLE RIVER
Practice Address - State:SC
Practice Address - Zip Code:29566-8143
Practice Address - Country:US
Practice Address - Phone:843-491-1480
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPLETE MEDICAL PRACTICE MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-06-29
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service