Provider Demographics
NPI:1356582597
Name:LOWCOUNTRY SPINE & SPORT, LLC
Entity type:Organization
Organization Name:LOWCOUNTRY SPINE & SPORT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BATSON
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:843-422-0781
Mailing Address - Street 1:300 NEW RIVER PKWY
Mailing Address - Street 2:BUILDING 2, SUITE 37
Mailing Address - City:HARDEEVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29927-4450
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 NEW RIVER PKWY
Practice Address - Street 2:BUILDING 2, SUITE 37
Practice Address - City:HARDEEVILLE
Practice Address - State:SC
Practice Address - Zip Code:29927-4450
Practice Address - Country:US
Practice Address - Phone:843-422-0781
Practice Address - Fax:800-210-2452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-18
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC22310204C00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC223109Medicaid
SC6346990001Medicare NSC
SCI34299Medicare UPIN