Organization
PAIN MANAGEMENT, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BERNICE K RICHARDSON (MEDICAL AFFAIRS MANAGER)
(803) 254-2394
Entity
Organization
Contact information
Practice address
1092 JOHNNIE DODDS BLVD, SUITE A2 LEFT, MT PLEASANT, SC 29464-6109
(843) 388-6552
Mailing address
PO BOX 2344, COLUMBIA, SC 29202-2344
(803) 254-2394
(803) 254-7125
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CH8246
RR MEDICARE
SC
01
—
GP3033
SELECT HEALTH
SC
05
—
GP3033
—
SC
Enumeration date
10/10/2006
Last updated
08/22/2020
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