Provider Demographics
NPI:1477758597
Name:CAROLINA PAIN CONSULTANTS
Entity type:Organization
Organization Name:CAROLINA PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:DUSSEL
Authorized Official - Last Name:PRITCHARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-818-0480
Mailing Address - Street 1:PO BOX 63214
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28263-3214
Mailing Address - Country:US
Mailing Address - Phone:704-818-0480
Mailing Address - Fax:704-818-0490
Practice Address - Street 1:610 SIGNAL HILL DRIVE EXT
Practice Address - Street 2:SUITE 100
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28625-4337
Practice Address - Country:US
Practice Address - Phone:704-818-0480
Practice Address - Fax:704-818-0490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-19
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18045261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CE8257OtherRR MEDICARE