Provider Demographics
NPI:1619475274
Name:SOUTHERN COAST PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:SOUTHERN COAST 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:
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 1:1000 PINE ST W
Practice Address - Street 2:
Practice Address - City:VARNVILLE
Practice Address - State:SC
Practice Address - Zip Code:29944-4750
Practice Address - Country:US
Practice Address - Phone:843-476-4702
Practice Address - Fax:843-476-4290
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHERN COAST PAIN SPECIALISTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-01-30
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC35457207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty