Healthcare Provider Details

I. General information

NPI: 1013898113
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2025
Last Update Date: 09/08/2025
Certification Date: 09/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 S 5TH ST
SAINT CHARLES MO
63301-2913
US

IV. Provider business mailing address

PO BOX 3891
CHESTERFIELD MO
63006-3891
US

V. Phone/Fax

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

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: RAMIS GHEITH
Title or Position: OWNER
Credential:
Phone: 636-933-2243