Provider Demographics
NPI:1124503255
Name:CAROLINA PAIN SCRAMBLER CENTER
Entity type:Organization
Organization Name:CAROLINA PAIN SCRAMBLER CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:FRAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:LONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-520-5011
Mailing Address - Street 1:103 S VENTURE DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29615-3571
Mailing Address - Country:US
Mailing Address - Phone:864-520-5011
Mailing Address - Fax:864-520-5011
Practice Address - Street 1:103 S VENTURE DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3571
Practice Address - Country:US
Practice Address - Phone:864-520-5011
Practice Address - Fax:864-520-5011
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-25
Last Update Date:2018-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty