Provider Demographics
NPI:1336491877
Name:L5 MEDICAL HOLDINGS LLC
Entity Type:Organization
Organization Name:L5 MEDICAL HOLDINGS LLC
Other - Org Name:PAIN CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:GREGORY
Authorized Official - Last Name:BARNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-270-1687
Mailing Address - Street 1:10 RESOLUTE LN STE 200
Mailing Address - Street 2:
Mailing Address - City:MOUNT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-6608
Mailing Address - Country:US
Mailing Address - Phone:843-352-9478
Mailing Address - Fax:888-977-2989
Practice Address - Street 1:4262 S AMHERST HWY STE 200
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:VA
Practice Address - Zip Code:24572-5363
Practice Address - Country:US
Practice Address - Phone:434-528-4640
Practice Address - Fax:888-977-2989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2019-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty