Provider Demographics
NPI:1891442869
Name:SOUTHCOAST SPINE AND PAIN LLC
Entity Type:Organization
Organization Name:SOUTHCOAST SPINE AND PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-224-8086
Mailing Address - Street 1:440 SOCIETY HILL DR STE 202
Mailing Address - Street 2:
Mailing Address - City:AIKEN
Mailing Address - State:SC
Mailing Address - Zip Code:29803-1755
Mailing Address - Country:US
Mailing Address - Phone:803-226-0102
Mailing Address - Fax:803-226-0384
Practice Address - Street 1:440 SOCIETY HILL DR STE 202
Practice Address - Street 2:
Practice Address - City:AIKEN
Practice Address - State:SC
Practice Address - Zip Code:29803-1755
Practice Address - Country:US
Practice Address - Phone:803-226-0102
Practice Address - Fax:803-226-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-09
Last Update Date:2022-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty