| Ccamp Carolina Pain Center | |
|
279 E Kennedy St Spartanburg SC 29302-1912 | |
| (864) 583-0053 | |
| (864) 583-0390 |
| Full Name | Ccamp Carolina Pain Center |
|---|---|
| Speciality | Pain Medicine |
| Location | 279 E Kennedy St, Spartanburg, South Carolina |
| Authorized Official Name and Position | Janice N Cash (PRACTICE MANAGER) |
| Authorized Official Contact | 8645830053 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ccamp Carolina Pain Center Po Box 6130 Spartanburg SC 29304-6130 Ph: (864) 583-0053 | Ccamp Carolina Pain Center 279 E Kennedy St Spartanburg SC 29302-1912 Ph: (864) 583-0053 |
| NPI Number | 1750304002 |
|---|---|
| Provider Enumeration Date | 07/26/2006 |
| Last Update Date | 03/27/2024 |
| Certification Date | 03/27/2024 |
| Medicare PECOS PAC ID | 4880593771 |
|---|---|
| Medicare Enrollment ID | O20040108000894 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750304002 | NPI | - | NPPES |
| 013KE | Other | NC | BCBS |
| 890652K | Medicaid | NC | |
| GP1456 | Medicaid | SC |
| Provider Name | Justin Kelby Hutcheson |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1154421915 PECOS PAC ID: 1557307469 Enrollment ID: I20050630000776 |
| Provider Name | Renju T Joseph |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1649296690 PECOS PAC ID: 4587690235 Enrollment ID: I20050713000927 |
| Provider Name | John C Haasis |
|---|---|
| Provider Type | Practitioner - Pain Management |
| Provider Identifiers | NPI Number: 1710908496 PECOS PAC ID: 4587622626 Enrollment ID: I20080310000077 |
| Provider Name | Charles David Tollison |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1710900964 PECOS PAC ID: 0446376693 Enrollment ID: I20100925000195 |
| Provider Name | Robert Steven Westrol |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1497796916 PECOS PAC ID: 8820091457 Enrollment ID: I20101019000686 |
| Provider Name | Christina Garrett |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326434283 PECOS PAC ID: 0042517567 Enrollment ID: I20160329001595 |
| Provider Name | Emmanuel Shakib Sakla |
|---|---|
| Provider Type | Practitioner - Physical Medicine And Rehabilitation |
| Provider Identifiers | NPI Number: 1992147029 PECOS PAC ID: 5092068825 Enrollment ID: I20191108001613 |
| Provider Name | Daphne Areephanthu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1073104790 PECOS PAC ID: 2062827512 Enrollment ID: I20210216002068 |
| Provider Name | Reajean C Camacho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134497159 PECOS PAC ID: 8224396593 Enrollment ID: I20210218000099 |
| Provider Name | Toshiva Deshane Shippy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902540172 PECOS PAC ID: 4183001084 Enrollment ID: I20220516000707 |
| Provider Name | Tiffany Ballington |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1093470296 PECOS PAC ID: 3375920002 Enrollment ID: I20220518000472 |
| Provider Name | Amy H Ash |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1053928903 PECOS PAC ID: 0345398707 Enrollment ID: I20220523000188 |
| Provider Name | Alexander Kieber |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1396232450 PECOS PAC ID: 3577945294 Enrollment ID: I20230801004627 |
| Provider Name | Taylor Ellis Clark |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1952008351 PECOS PAC ID: 7517329345 Enrollment ID: I20230810003924 |
| Provider Name | Edna Frazier |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215649660 PECOS PAC ID: 3173985306 Enrollment ID: I20230818002477 |
| Provider Name | Nisarg Patel |
|---|---|
| Provider Type | Practitioner - Interventional Pain Management |
| Provider Identifiers | NPI Number: 1760979983 PECOS PAC ID: 2062767718 Enrollment ID: I20231008000052 |
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