Healthcare Provider Details

I. General information

NPI: 1992587968
Provider Name (Legal Business Name): ST LOUIS PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2023
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4455 TELEGRAPH RD STE 250
SAINT LOUIS MO
63129-3354
US

IV. Provider business mailing address

4455 TELEGRAPH RD STE 250
SAINT LOUIS MO
63129-3354
US

V. Phone/Fax

Practice location:
  • Phone: 314-846-2100
  • Fax: 314-846-4975
Mailing address:
  • Phone: 314-846-2100
  • Fax: 314-846-4975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: ANDREW MORNINGSTAR
Title or Position: MANAGING PARTNER
Credential: DC
Phone: 636-244-0124