Provider Demographics
NPI:1679118657
Name:PAIN MEDICINE SPECIALISTS, PA
Entity type:Organization
Organization Name:PAIN MEDICINE SPECIALISTS, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:SEMKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:503-866-1438
Mailing Address - Street 1:1750 HIGHWAY 160 WEST
Mailing Address - Street 2:SUITE 101#319
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-1759
Mailing Address - Country:US
Mailing Address - Phone:803-802-7100
Mailing Address - Fax:803-802-8378
Practice Address - Street 1:3410 SUNSET BLVD
Practice Address - Street 2:
Practice Address - City:WEST COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29169-3042
Practice Address - Country:US
Practice Address - Phone:803-791-9200
Practice Address - Fax:803-791-9207
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT73364Medicaid