Provider Demographics
NPI:1104914076
Name:PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL AFFAIRS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BERNICE
Authorized Official - Middle Name:K
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-254-2394
Mailing Address - Street 1:PO BOX 2344
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29202-2344
Mailing Address - Country:US
Mailing Address - Phone:803-254-2394
Mailing Address - Fax:803-254-7125
Practice Address - Street 1:1092 JOHNNIE DODDS BLVD
Practice Address - Street 2:SUITE A2 LEFT
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-6109
Practice Address - Country:US
Practice Address - Phone:843-388-6552
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP3033Medicaid
SCGP3033OtherSELECT HEALTH
SCCH8246OtherRR MEDICARE
SC6943Medicare ID - Type Unspecified