SOUTHERN GRACE PAIN & REGENERATIVE MEDICINE (NPI# 1942836754) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1942836754 |
| Entity Type | Organization |
| Organization Name | SOUTHERN GRACE PAIN & REGENERATIVE MEDICINE |
| Practice Address |
3520 Park Avenue Blvd., Suite 105 Mount Pleasant SC 29466 |
| Mailing Address |
2256 Beckenham Dr Mt Pleasant SC 29466-9009 |
| Practice Telephone | 8437544231 |
| Mailing Telephone | 8437544231 |
| Enumeration Date | 2020-03-13 |
| Last Update Date | 2020-03-13 |
| Authorized Official Name | DR. WILLIAM BLANE BLANE RICHARDSON (PROVIDER/OWNER) |
| Authorized Official Telephone | 8437544231 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QP3300X |
Clinic/Center Specialization: Pain |
Ambulatory Health Care Facilities |
| Street Address |
3520 PARK AVENUE BLVD., SUITE 105 |
| City | MOUNT PLEASANT |
| State | SC |
| Zip Code | 29466 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1720689276 | Sweetgrass Pharmacy Carolina Park, LLC | Pharmacy | 3485 Park Avenue Blvd, Mount Pleasant, SC 29466 | 2020-11-02 |
| 1174175038 | South Carolina Cvs Pharmacy LLC | Durable Medical Equipment & Medical Supplies | 225 Faison Rd, Mount Pleasant, SC 29466 | 2019-07-11 |
| 1780246553 | Stacy Nicole Sherbutt | Dental Hygienist | Naval Weapons Statiom, 316 Red Bank Rd, Goose Creek, SC 29466 | 2019-07-02 |
| 1144780909 | Chantal Pilar Debreceny | Nurse Practitioner | 1167 Basketweave Drive, #204, Mount Pleasant, SC 29466 | 2019-03-20 |
| 1609364835 | Costco Wholesale Corporation | Eyewear Supplier (Equipment, not the service) | 3525 Park Ave Blvd., Mount Pleasant, SC 29466 | 2018-04-24 |
| 1528561453 | Sea Island Medical Care | Clinic/Center | 2114 Highway 41, Suite 105, Mount Pleasant, SC 29466 | 2018-03-16 |
| 1992217707 | Kristina Estelle Johnson | Family Medicine | 2662, Lohr Dr, Mount Pleasant, SC 29466 | 2017-11-02 |
| 1801324181 | Collin T Weyer | Physical Therapist | 3301 Stockdale Street, Suite B, Mt. Pleasant, SC 29466 | 2017-05-31 |
| 1023467479 | Mariesa Eikevik | Physical Therapist | 3559 Franklin Tower Dr, Mount Pleasant, SC 29466 | 2016-06-07 |
| 1023401239 | Avani Patel | Specialist/Technologist, Other | 1300 Park West Blvd., Madison At Park West Apt 107, Mount Pleasant, SC 29466 | 2015-03-12 |
| Find all providers in zip 29466 | ||||
| Taxonomy Code | 261QP3300X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Pain |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1689954950 | Dean Pain Management Sc | Clinic/Center | 6520 Casper Ct, Mount Pleasant, WI 53406-5811 | 2011-08-18 |
| 1568493849 | Big Fish Physical Medicine, LLC | Clinic/Center | 3400 Salterbeck Ct, Suite 102, Mount Pleasant, SC 29466-7118 | 2006-07-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1851743389 | Sent, LLC | Clinic/Center | 425 Summit Terrace Ct Bldg 1, Columbia, SC 29229-7055 | 2016-07-08 |
| 1396161808 | Southeast Neuropathy & Treatment Center, LLC | Clinic/Center | 1494 Lake Murray Blvd, 1st Floor, Columbia, SC 29212-8697 | 2014-03-07 |
| 1427494939 | Musc | Clinic/Center | 165 Cannon St, Suite 503, Charleston, SC 29425-7901 | 2013-05-13 |
| 1891317228 | Max Primary Care LLC | Clinic/Center | 309 W Palmetto St, Florence, SC 29501-4417 | 2020-05-07 |
| 1891237632 | Prisma Health-upstate | Clinic/Center | 102b Omni Dr, Seneca, SC 29672 | 2016-11-10 |
| 1750793519 | Trade Street Massage LLC | Clinic/Center | 210 W Stone Ave, Lr3, Greenville, SC 29609-5452 | 2014-05-28 |
| 1134106693 | Oaktree Medical Centre, PC | Clinic/Center | 200 Patewood Dr, Suite A 350, Greenville, SC 29615-3593 | 2005-12-27 |
| City | MOUNT PLEASANT |
| Zip Code | 29466 |
Please comment or provide details below to improve the information on SOUTHERN GRACE PAIN & REGENERATIVE MEDICINE.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.