Provider Demographics
NPI:1275568149
Name:CAROLINA INTERVENTIONAL PAIN ASSOCIATES, P.A
Entity Type:Organization
Organization Name:CAROLINA INTERVENTIONAL PAIN ASSOCIATES, P.A
Other - Org Name:PAIN MEDICINE SPECIALIST
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GISELE
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:GIRAULT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-802-7100
Mailing Address - Street 1:1750 HIGHWAY 160 WEST, SUITE 1010-319
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708
Mailing Address - Country:US
Mailing Address - Phone:803-802-7100
Mailing Address - Fax:803-791-9200
Practice Address - Street 1:342 PATRICIA LANE
Practice Address - Street 2:SUITE 102
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708
Practice Address - Country:US
Practice Address - Phone:803-802-7100
Practice Address - Fax:803-791-9200
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207LA0401XAllopathic & Osteopathic PhysiciansAnesthesiologyAddiction MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3866Medicaid
SCGP4369Medicaid
SCGP4369Medicaid