Healthcare Provider Details

I. General information

NPI: 1093828584
Provider Name (Legal Business Name): COLUMBIA INTERVENTIONAL PAIN CENTER LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 09/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 N KEENE ST SUITE #105
COLUMBIA MO
65201-6897
US

IV. Provider business mailing address

PO BOX 7237
COLUMBIA MO
65205-7237
US

V. Phone/Fax

Practice location:
  • Phone: 573-442-2299
  • Fax: 573-442-3196
Mailing address:
  • Phone: 573-468-6501
  • Fax: 573-468-6502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. JULIA A MESTON
Title or Position: ADMINISTRATOR
Credential:
Phone: 573-442-2299