Provider Demographics
NPI:1760534358
Name:SOUTHEASTERN SPINE INSTITUTE,LLC
Entity Type:Organization
Organization Name:SOUTHEASTERN SPINE INSTITUTE,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:FRISCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-849-1551
Mailing Address - Street 1:1625 HOSPITAL DR STE 200
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:SC
Mailing Address - Zip Code:29464-3892
Mailing Address - Country:US
Mailing Address - Phone:843-849-1551
Mailing Address - Fax:843-849-6591
Practice Address - Street 1:1625 HOSPITAL DR STE 200
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3698
Practice Address - Country:US
Practice Address - Phone:843-849-1551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-17
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC207XS0117X
208100000X, 208VP0014X, 261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3652Medicaid
SC20093922OtherTRICARE
SCDA0067OtherMEDICARE RAILROAD
4861350002OtherMEDICARE DMERC
SC=========OtherSTANDARD TAX ID
SC20093922OtherTRICARE
SC=========OtherBCBS OF SC
SC=========OtherSTANDARD TAX ID
SC=========OtherBCBS OF SC