Provider Demographics
NPI:1043540222
Name:CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
Entity type:Organization
Organization Name:CAROLINAS CENTER FOR ADVANCED MANAGEMENT OF PAIN, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:Y EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRONER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:864-583-0053
Mailing Address - Street 1:PO BOX 6130
Mailing Address - Street 2:
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29304-6130
Mailing Address - Country:US
Mailing Address - Phone:864-583-0053
Mailing Address - Fax:864-583-0390
Practice Address - Street 1:10 ENTERPRISE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-3554
Practice Address - Country:US
Practice Address - Phone:864-295-9609
Practice Address - Fax:864-295-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2020-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC184375207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCGP2967Medicaid
SC6655Medicare PIN
SC1180470001Medicare NSC