Provider Demographics
NPI:1780940312
Name:WACCAMAW PAIN GROUP, LLC
Entity type:Organization
Organization Name:WACCAMAW PAIN GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED REPRESENTATIVE
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:KAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:843-652-1100
Mailing Address - Street 1:4040 HIGHWAY 17 BYPASS
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MURRELLS INLET
Mailing Address - State:SC
Mailing Address - Zip Code:29576-5033
Mailing Address - Country:US
Mailing Address - Phone:843-652-8260
Mailing Address - Fax:
Practice Address - Street 1:4040 HIGHWAY 17 BYPASS
Practice Address - Street 2:SUITE 206
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5033
Practice Address - Country:US
Practice Address - Phone:843-652-8260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty