Healthcare Provider Details

I. General information

NPI: 1942976170
Provider Name (Legal Business Name): NEUROPATHY AND PAIN SOLUTIONS OF SOUTH COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2021
Last Update Date: 08/19/2021
Certification Date: 08/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4109 UNION RD
SAINT LOUIS MO
63129-1064
US

IV. Provider business mailing address

4109 UNION RD
SAINT LOUIS MO
63129-1064
US

V. Phone/Fax

Practice location:
  • Phone: 618-233-4458
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: BRANDON WILLIAMS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 618-233-4458