Provider Demographics
NPI:1316283062
Name:CAROLINA PAIN PHYSICIANS
Entity type:Organization
Organization Name:CAROLINA PAIN PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TONY
Authorized Official - Middle Name:LAMAR
Authorized Official - Last Name:OWENS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:843-737-0437
Mailing Address - Street 1:9404 HIGHWAY 78 SUITE 100
Mailing Address - Street 2:
Mailing Address - City:LADSON
Mailing Address - State:SC
Mailing Address - Zip Code:29456-3909
Mailing Address - Country:US
Mailing Address - Phone:843-737-0437
Mailing Address - Fax:843-789-3053
Practice Address - Street 1:9404 HIGHWAY 78 SUITE 100
Practice Address - Street 2:
Practice Address - City:LADSON
Practice Address - State:SC
Practice Address - Zip Code:29456-3909
Practice Address - Country:US
Practice Address - Phone:843-737-0437
Practice Address - Fax:843-789-3053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-28
Last Update Date:2020-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC33911207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC339119Medicaid