Provider Demographics
NPI:1194914655
Name:CAROLINA SPINE & PAIN CENTER, PLLC
Entity type:Organization
Organization Name:CAROLINA SPINE & PAIN CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:HINES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-360-2260
Mailing Address - Street 1:170 MEDICAL PARK RD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-8540
Mailing Address - Country:US
Mailing Address - Phone:704-360-2260
Mailing Address - Fax:704-360-2274
Practice Address - Street 1:170 MEDICAL PARK RD
Practice Address - Street 2:SUITE 310
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-8540
Practice Address - Country:US
Practice Address - Phone:704-360-2260
Practice Address - Fax:704-360-2274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2011-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-0606992-1208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCG74518Medicare UPIN
NC2339085Medicare PIN
NC4689130001Medicare NSC