Provider Demographics
NPI:1922000702
Name:ALLEN L SLOAN MD PC
Entity Type:Organization
Organization Name:ALLEN L SLOAN MD PC
Other - Org Name:CSRA PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ALLEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-202-0053
Mailing Address - Street 1:1168 W MARTINTOWN RD
Mailing Address - Street 2:
Mailing Address - City:NORTH AUGUSTA
Mailing Address - State:SC
Mailing Address - Zip Code:29841-2046
Mailing Address - Country:US
Mailing Address - Phone:803-202-0053
Mailing Address - Fax:803-202-0018
Practice Address - Street 1:1168 W MARTINTOWN RD
Practice Address - Street 2:
Practice Address - City:NORTH AUGUSTA
Practice Address - State:SC
Practice Address - Zip Code:29841-2046
Practice Address - Country:US
Practice Address - Phone:803-202-0053
Practice Address - Fax:803-202-0018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-11
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC14285207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00378672DMedicaid
SC142851Medicaid
SC142851Medicaid
E19879Medicare UPIN
7934Medicare PIN