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General NPI Number Information
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NPI Number | 1265614077
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Entity Type | Organization
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Legal Business Name | MIDWEST PAIN CENTER, LLC.
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Dates
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Enumeration Date | 12/04/2007
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 17300 N OUTER 40 STE. 100
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1364
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Country | US
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Telephone | 636-519-8889
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Fax | 636-536-0120
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Provider Business Mailing Address
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Address Line | 17300 N OUTER 40 STE. 100
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City | CHESTERFIELD
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State | MO
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Zip | 63005-1364
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Country | US
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Telephone | 636-519-8889
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Fax | 636-536-0120
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Authorized Official
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Title or Position | OWNER
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Name | DR. STEPHEN G. SMITH
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Credential | M.D.
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Telephone | 636-519-8889
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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 | R3N29
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License Number State | MO
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