Provider Demographics
NPI:1508518069
Name:SOUTHERN COAST SPINE & PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:SOUTHERN COAST SPINE & PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:BJ
Authorized Official - Last Name:SCHUYLER
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-476-4702
Mailing Address - Street 1:1055 RIBAUT RD STE 30
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:SC
Mailing Address - Zip Code:29902-5447
Mailing Address - Country:US
Mailing Address - Phone:843-476-4702
Mailing Address - Fax:843-476-4290
Practice Address - Street 1:1055 RIBAUT RD STE 30
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:SC
Practice Address - Zip Code:29902-5447
Practice Address - Country:US
Practice Address - Phone:843-476-4702
Practice Address - Fax:843-476-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-25
Last Update Date:2022-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty