Healthcare Provider Details

I. General information

NPI: 1467186411
Provider Name (Legal Business Name): ADVANCED PAIN RELIEF CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/14/2022
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4710 MEXICO RD STE B
SAINT PETERS MO
63376-1663
US

IV. Provider business mailing address

4710 MEXICO RD STE B
SAINT PETERS MO
63376-1663
US

V. Phone/Fax

Practice location:
  • Phone: 636-244-0124
  • Fax:
Mailing address:
  • Phone: 636-244-0124
  • Fax: 636-400-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

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