Provider Demographics
NPI:1376598268
Name:CAROLINAS PAIN INSTITUTE, PA
Entity Type:Organization
Organization Name:CAROLINAS PAIN INSTITUTE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:RAUCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:336-765-6181
Mailing Address - Street 1:145 KIMEL PARK
Mailing Address - Street 2:SUITE 330
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-765-6181
Mailing Address - Fax:336-765-8492
Practice Address - Street 1:145 KIMEL PARK DR
Practice Address - Street 2:SUITE 330
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103-6984
Practice Address - Country:US
Practice Address - Phone:336-765-6181
Practice Address - Fax:336-765-8492
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC30458208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5902221Medicaid
70536OtherBCBS
NC7970536Medicaid
NC5902221Medicaid
NC7970536Medicaid
NC6189940001Medicare NSC
70536OtherBCBS