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Organization

LOW COUNTRY PAIN CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
AVINASH GUPTA M.D. (OWNER)
(803) 531-0029
Entity
Organization

Contact information

Practice address
793 COOK ROAD, ORANGEBURG, SC 29118-9008
(803) 531-8808
(803) 531-3330
Mailing address
PO BOX 4860, MURRELLS INLET, SC 29576-2698
(800) 951-7850
(843) 357-4940

Taxonomy

Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
21478
SC
208VP0014X
Interventional Pain Medicine Physician
21478
SC

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
GP4122
SC
Enumeration date
07/09/2008
Last updated
12/30/2014
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