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General NPI Number Information
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NPI Number | 1093828584
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Entity Type | Organization
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Legal Business Name | COLUMBIA INTERVENTIONAL PAIN CENTER LLP
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 09/24/2014
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Provider Practice Location Address
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Address Line | 305 N KEENE ST SUITE #105
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City | COLUMBIA
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State | MO
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Zip | 65201-6897
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Country | US
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Telephone | 573-442-2299
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Fax | 573-442-3196
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Provider Business Mailing Address
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Address Line | PO BOX 7237
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City | COLUMBIA
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State | MO
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Zip | 65205-7237
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Country | US
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Telephone | 573-468-6501
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Fax | 573-468-6502
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MS. JULIA A MESTON
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Credential |
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Telephone | 573-442-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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