Provider Demographics
NPI:1861983249
Name:SOUTHERN PAIN SPECIALISTS
Entity type:Organization
Organization Name:SOUTHERN PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:M
Authorized Official - Last Name:TUEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:803-419-5345
Mailing Address - Street 1:115 BLARNEY DR STE 111
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29223-6291
Mailing Address - Country:US
Mailing Address - Phone:803-419-5345
Mailing Address - Fax:
Practice Address - Street 1:115 BLARNEY DR STE 111
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29223
Practice Address - Country:US
Practice Address - Phone:803-419-5345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-22
Last Update Date:2019-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCMD182682081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCMD18268OtherSC MEDICAL LICENSE