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General NPI Number Information
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NPI Number | 1134215247
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Entity Type | Organization
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Legal Business Name | ST LOUIS PAIN MANAGEMENT CENTER INC
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Dates
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Enumeration Date | 10/05/2006
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 11605 STUDT AVE SUITE 120
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City | SAINT LOUIS
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State | MO
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Zip | 63141-7052
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Country | US
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Telephone | 314-432-2580
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Fax | 314-569-3162
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Provider Business Mailing Address
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Address Line | PO BOX 1209
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City | MARYLAND HEIGHTS
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State | MO
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Zip | 63043-0209
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Country | US
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Telephone | 314-432-2580
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Fax | 314-432-0223
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Authorized Official
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Title or Position | ACCT MANAGER
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Name | KIM DEBOLD
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Credential |
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Telephone | 314-432-2580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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