Provider Demographics
NPI:1467012021
Name:PAIN SPECIALISTS OF CHARLESTON
Entity Type:Organization
Organization Name:PAIN SPECIALISTS OF CHARLESTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
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:843-408-0386
Mailing Address - Fax:
Practice Address - Street 1:2683 ELMS PLANTATION BLVD
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29406-7119
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:2019-06-17
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1508833468OtherNPI