Healthcare Provider Details

I. General information

NPI: 1407384944
Provider Name (Legal Business Name): IPRRI LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2017
Last Update Date: 05/29/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10435 CLAYTON RD STE 120
SAINT LOUIS MO
63131-2930
US

IV. Provider business mailing address

970 N SPOEDE RD APT 16
SAINT LOUIS MO
63146-5566
US

V. Phone/Fax

Practice location:
  • Phone: 314-985-3002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. ZHENG HU
Title or Position: OFFICE MANAGER
Credential:
Phone: 412-390-4966