Provider Demographics
NPI:1376574855
Name:CROWFIELD PAIN CENTER
Entity Type:Organization
Organization Name:CROWFIELD PAIN CENTER
Other - Org Name:EDISTO SPINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:H
Authorized Official - Last Name:FAABERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-563-4506
Mailing Address - Street 1:5790 MEMORIAL BOULEVARD
Mailing Address - Street 2:
Mailing Address - City:SAINT GEORGE
Mailing Address - State:SC
Mailing Address - Zip Code:29477
Mailing Address - Country:US
Mailing Address - Phone:843-563-4506
Mailing Address - Fax:843-563-4845
Practice Address - Street 1:5790 MEMORIAL BOULEVARD
Practice Address - Street 2:
Practice Address - City:SAINT GEORGE
Practice Address - State:SC
Practice Address - Zip Code:29477
Practice Address - Country:US
Practice Address - Phone:843-563-4506
Practice Address - Fax:843-563-4845
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2010-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15434207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCB72305Medicare UPIN
SC5033Medicare ID - Type UnspecifiedGROUP