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General NPI Number Information
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NPI Number | 1043762974
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Entity Type | Organization
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Legal Business Name | ST LOUIS SPINE AND JOINT PAIN SPECIALISTS LLC
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Dates
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Enumeration Date | 10/26/2016
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Last Update Date | 01/15/2020
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Provider Practice Location Address
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Address Line | 520 CENTER STREET
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City | FENTON
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State | MO
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Zip | 63026-4246
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Country | US
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Telephone | 314-516-3289
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Fax |
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Provider Business Mailing Address
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Address Line | 520 CENTER STREET
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City | FENTON
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State | MO
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Zip | 63026
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Country | US
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Telephone | 314-516-3289
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Fax |
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Authorized Official
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Title or Position | CHIEF OFFICER
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Name | ADAM SHOMSTEIN
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Credential | DO
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Telephone | 314-516-3289
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 2016035827
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License Number State | MO
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