Organization
PEE DEE PAIN CARE, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LISA MANCUSO M.D. (OWNER)
(843) 350-0100
Entity
Organization
Contact information
Practice address
552 W CAROLINA AVE, HARTSVILLE, SC 29550-5412
(843) 350-0100
Mailing address
PO BOX 100523, FLORENCE, SC 29502-0523
(843) 669-5162
Taxonomy
Speciality
Code
Description
License number
State
208VP0000X
Pain Medicine Physician
Primary
23676
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
236765
—
SC
Enumeration date
04/20/2009
Last updated
08/27/2015
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