Provider Demographics
NPI:1255423497
Name:CAROLINA CENTER FOR PAIN & REHABILITATION
Entity type:Organization
Organization Name:CAROLINA CENTER FOR PAIN & REHABILITATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:WARMOTH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-571-2200
Mailing Address - Street 1:PO BOX 31129
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29417-1129
Mailing Address - Country:US
Mailing Address - Phone:843-571-2200
Mailing Address - Fax:
Practice Address - Street 1:316 CALHOUN ST
Practice Address - Street 2:@ ROPER REHABILITATION
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29401-1113
Practice Address - Country:US
Practice Address - Phone:843-571-2200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCSC7116174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC07116Medicaid
SC07116Medicaid