Healthcare Provider Details

I. General information

NPI: 1538584594
Provider Name (Legal Business Name): AMERICAN PAIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2014
Last Update Date: 09/22/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2730 S SAINT PETERS PKWY SUITE 104
SAINT PETERS MO
63303-5677
US

IV. Provider business mailing address

2730 S SAINT PETERS PKWY SUITE 104
SAINT PETERS MO
63303-5677
US

V. Phone/Fax

Practice location:
  • Phone: 314-972-3107
  • Fax:
Mailing address:
  • Phone: 314-972-3107
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number713780001
License Number StateMO

VIII. Authorized Official

Name: DR. JERRY DALE LEECH JR.
Title or Position: CHIEF OF STAFF
Credential: D.C.
Phone: 314-972-3107