Basic Information
| Provider Information | |||||||||
| NPI: | 1215302823 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LOW COUNTRY PAIN & SPINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 4860 | ||||||||
| Address2: | |||||||||
| City: | MURRELLS INLET | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295762698 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436512624 | ||||||||
| FaxNumber: | 8434914023 | ||||||||
| Practice Location | |||||||||
| Address1: | 9180 OCEAN HWY UNIT 6 | ||||||||
| Address2: | |||||||||
| City: | PAWLEYS ISLAND | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295858670 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123219112 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/08/2015 | ||||||||
| LastUpdateDate: | 12/08/2015 | ||||||||
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| AuthorizedOfficialLastName: | CAMERANSI | ||||||||
| AuthorizedOfficialFirstName: | BENJAMIN | ||||||||
| AuthorizedOfficialMiddleName: | GEORGE | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR/OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9123219112 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNameSuffix: | JR. | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 21121 | SC | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 207L00000X | 21121 | SC | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.