Healthcare Provider Details

I. General information

NPI: 1659426351
Provider Name (Legal Business Name): PAIN MANAGEMENT CONSULTANTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

204 SEMINARY STREET
WARSAW MO
65355
US

IV. Provider business mailing address

P.O. BOX 789
WARSAW MO
65355
US

V. Phone/Fax

Practice location:
  • Phone: 660-438-6993
  • Fax:
Mailing address:
  • Phone: 660-438-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number2001015367
License Number StateMO

VIII. Authorized Official

Name: DR. WILLIAM E CARLILE
Title or Position: OWNER
Credential: MD
Phone: 660-438-6993