Provider Demographics
NPI:1700933066
Name:PAIN SOLUTIONS INC
Entity Type:Organization
Organization Name:PAIN SOLUTIONS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MASSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PT
Authorized Official - Phone:803-920-6350
Mailing Address - Street 1:100 OLD CHEROKEE ROAD
Mailing Address - Street 2:SUITE F, PMB 310
Mailing Address - City:LEXINGTON
Mailing Address - State:SC
Mailing Address - Zip Code:29072-7959
Mailing Address - Country:US
Mailing Address - Phone:803-296-5990
Mailing Address - Fax:
Practice Address - Street 1:223 STONERIDGE DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29210-8009
Practice Address - Country:US
Practice Address - Phone:803-296-5990
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2007-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1095261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1915OtherLICENSE # - DEBRA IACONO
SC1095OtherLICENSE # - KIM MASSEY
SC958OtherLICENSE # - RUSSELL MASSE
SC7883Medicare PIN