Healthcare Provider Details

I. General information

NPI: 1861832503
Provider Name (Legal Business Name): ST LOUIS NEUROPATHY AND PAIN RELIEF CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10777 SUNSET OFFICE DR STE 40
SAINT LOUIS MO
63127-1019
US

IV. Provider business mailing address

10777 SUNSET OFFICE DR STE 40
SAINT LOUIS MO
63127-1019
US

V. Phone/Fax

Practice location:
  • Phone: 314-222-0060
  • Fax: 314-222-0111
Mailing address:
  • Phone: 314-222-0060
  • Fax: 314-222-0111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number27603
License Number StateMO

VIII. Authorized Official

Name: DR. HERBERT SHAPIRO
Title or Position: OWNER
Credential: M.D.
Phone: 314-222-0060