Healthcare Provider Details

I. General information

NPI: 1063772903
Provider Name (Legal Business Name): PAIN RELIEF PARTNERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2012
Last Update Date: 09/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

113 W 5TH ST
EUREKA MO
63025-1109
US

IV. Provider business mailing address

1585 WOODLAKE DR SUITE 214
CHESTERFIELD MO
63017-5740
US

V. Phone/Fax

Practice location:
  • Phone: 314-275-8737
  • Fax: 314-205-1508
Mailing address:
  • Phone: 314-275-8737
  • Fax: 314-205-1508

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MICHEAL VISHION
Title or Position: OWNER
Credential:
Phone: 314-275-8737