Provider Demographics
NPI:1427079698
Name:COASTAL PAIN AND SPINE CENTER, INC
Entity type:Organization
Organization Name:COASTAL PAIN AND SPINE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:L
Authorized Official - Last Name:CRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:843-757-6744
Mailing Address - Street 1:38 SHERIDAN PARK CIR
Mailing Address - Street 2:SUITE F
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-7022
Mailing Address - Country:US
Mailing Address - Phone:843-757-6744
Mailing Address - Fax:843-757-6743
Practice Address - Street 1:38 SHERIDAN PARK CIR
Practice Address - Street 2:SUITE F
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-7022
Practice Address - Country:US
Practice Address - Phone:843-757-6744
Practice Address - Fax:843-757-6743
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18399174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC183991Medicaid
SCP00203769OtherRAILROAD MEDICARE ID NUMB
SC8084OtherMEDICARE PTAN
SCGP4057Medicaid
SCG37955Medicare UPIN