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General NPI Number Information
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NPI Number | 1083098115
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Entity Type | Organization
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Legal Business Name | ELITE PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 07/18/2015
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Last Update Date | 02/26/2019
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Provider Practice Location Address
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Address Line | 1601 K66 STE C
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City | GALENA
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State | KS
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Zip | 66739-4306
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Country | US
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Telephone | 417-553-1404
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Fax | 417-553-1604
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Provider Business Mailing Address
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Address Line | 222 E PRIMROSE ST STE E
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City | SPRINGFIELD
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State | MO
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Zip | 65807-5233
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Country | US
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Telephone | 417-888-0167
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Fax | 417-888-0189
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Authorized Official
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Title or Position | OPERATIONS ASSISTANT
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Name | ARIES E SPARKS
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Credential |
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Telephone | 417-888-0167
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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