Healthcare Provider Details

I. General information

NPI: 1457727752
Provider Name (Legal Business Name): ELITE PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2015
Last Update Date: 07/16/2020
Certification Date: 07/16/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4237 RIVER HILLS DR
LITTLE RIVER SC
29566-6444
US

IV. Provider business mailing address

4237 RIVER HILLS DR
LITTLE RIVER SC
29566-6444
US

V. Phone/Fax

Practice location:
  • Phone: 417-848-9188
  • Fax:
Mailing address:
  • Phone: 417-848-9188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DAVID M TONKIN
Title or Position: OWNER
Credential: MD
Phone: 417-848-9188