Pee Dee Pain Care, LLC

Primary specialty

Pain Medicine PhysicianTaxonomy code 208VP0000X

License

23676 Issued in SC

Legal business name

PEE DEE PAIN CARE, LLC

Practice address

552 W Carolina Ave
Hartsville, SC 29550-5412

Phone

(843) 350-0100

NPI assigned

Apr 20, 2009

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Lisa Mancuso, M.D.

Title

Owner

Phone

(843) 350-0100

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1440633600000",
    "number": "1508009614",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 100523",
            "city": "FLORENCE",
            "state": "SC",
            "postal_code": "295020523",
            "telephone_number": "843-669-5162"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "552 W CAROLINA AVE",
            "city": "HARTSVILLE",
            "state": "SC",
            "postal_code": "295505412",
            "telephone_number": "843-350-0100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PEE DEE PAIN CARE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2015-08-27",
        "status": "A",
        "authorized_official_last_name": "MANCUSO",
        "authorized_official_first_name": "LISA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "843-350-0100",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "208VP0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "SC",
            "license": "23676",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "236765",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Pee Dee Emergency Physicians
• Pee Dee Eye Associates PA
• Pee Dee Healthcare PA
• Pee Dee Mental Health
• Pee Dee Mental Health
• Leslie J Pell, PHARMD
• Joni Cranford Pendergrass
• Katherine Hines Pennington, MSP, CCC-SLP
• Perfect Works Medical Solutions, LLC
• Kelly Ott Perkins, RN

• Pain Medicine Physician in Hartsville, SC
• Providers in Hartsville, SC by specialty
• Pain Medicine Physician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.