Healthcare Provider Details

I. General information

NPI: 1336461771
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 N TRUMAN BLVD
FESTUS MO
63028-1177
US

IV. Provider business mailing address

1405 N TRUMAN BLVD
FESTUS MO
63028-1177
US

V. Phone/Fax

Practice location:
  • Phone: 636-933-2243
  • Fax: 636-933-2252
Mailing address:
  • Phone: 636-933-2243
  • Fax: 636-933-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateMO

VIII. Authorized Official

Name: RAMIS GHEITH
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 636-933-2243