Provider Demographics
NPI:1770597924
Name:PAIN MANAGEMENT ASC LLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT ASC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BETH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-681-5062
Mailing Address - Street 1:PO BOX 22120
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD
Mailing Address - State:SC
Mailing Address - Zip Code:29925-2120
Mailing Address - Country:US
Mailing Address - Phone:843-681-5062
Mailing Address - Fax:843-681-5063
Practice Address - Street 1:11 HOSPITAL CENTER CMNS
Practice Address - Street 2:SUITE 100
Practice Address - City:HILTON HEAD
Practice Address - State:SC
Practice Address - Zip Code:29926-2844
Practice Address - Country:US
Practice Address - Phone:843-681-5062
Practice Address - Fax:843-681-5063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC15288174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3893Medicaid
SC42D1094640OtherCLIA
E37113Medicare UPIN
SCGP3893Medicaid
SC42D1094640OtherCLIA