MEDICARE: PAIN REHAB PRODUCTS, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	141100500	OTHER		DEPT OF LABOR
2	151181	OTHER	MO	BLUE CROSS/BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	39466	OTHER	MO	GROUP HEALTH PLAN
5	8200174	OTHER	MO	UNITED HEALTHCARE OF THE
6	450099	OTHER		HEALTHLINK

General Provider Information

NPI Number	:	1306930466
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN REHAB PRODUCTS, INC.

Provider Business Mailing Address
First Line	:	2339 WELDON PKWY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3207
Country	:	US
Telephone Number	:	314-832-7246
Fax Number	:	314-832-1430

Provider Business Practice Location Address
First Line	:	2339 WELDON PKWY
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63146-3207
Country	:	US
Telephone Number	:	314-832-7246
Fax Number	:	314-832-1430

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. GREGGORY FIXLEY
Credential	:
Telephone Number	:	314-832-7246

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	01/21/2014

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