Provider Demographics
NPI:1750304002
Name:CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
Entity Type:Organization
Organization Name:CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
Other - Org Name:CCAMP CAROLINA PAIN CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:N
Authorized Official - Last Name:CASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-583-0053
Mailing Address - Street 1:PO BOX 6130
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-6130
Mailing Address - Country:US
Mailing Address - Phone:864-583-0053
Mailing Address - Fax:864-583-0390
Practice Address - Street 1:279 E KENNEDY ST
Practice Address - Street 2:
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29302-1912
Practice Address - Country:US
Practice Address - Phone:864-583-0053
Practice Address - Fax:864-583-0390
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC013KEOtherBCBS
NC890652KMedicaid
SCGP1456Medicaid
SC1180470003OtherPTAN
SCGP1456Medicaid
SCGP2967Medicaid
NC2327774Medicare PIN
SC=========OtherBCBS
SC5640Medicare PIN
NC013KEOtherBCBS
SC6655Medicare PIN