Healthcare Provider Details

I. General information

NPI: 1841540382
Provider Name (Legal Business Name): ELPIS HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2012
Last Update Date: 09/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9918 GRANDVIEW FOREST CT
SAINT LOUIS MO
63127-0046
US

IV. Provider business mailing address

9918 GRANDVIEW FOREST CT
SAINT LOUIS MO
63127-0046
US

V. Phone/Fax

Practice location:
  • Phone: 573-268-6307
  • Fax:
Mailing address:
  • Phone: 573-268-6307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: VIVEK K MANCHANDA
Title or Position: CEO
Credential: M.D.
Phone: 573-268-6307