Provider Demographics
NPI:1376218404
Name:PAIN SPECIALISTS OF CHARLESTON
Entity Type:Organization
Organization Name:PAIN SPECIALISTS OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:TAVEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-408-0386
Mailing Address - Street 1:2695 ELMS PLANTATION BLVD STE A
Mailing Address - Street 2:
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:
Practice Address - Street 1:150 WALL ST STE A
Practice Address - Street 2:
Practice Address - City:PAWLEYS ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29585-5000
Practice Address - Country:US
Practice Address - Phone:843-408-0386
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN SPECIALISTS OF CHARLESTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-11
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty