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General NPI Number Information
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NPI Number | 1417629635
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Entity Type | Organization
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Legal Business Name | PACE MEDICAL, LLC
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Dates
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Enumeration Date | 10/05/2021
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Last Update Date | 10/12/2021
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Provider Practice Location Address
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Address Line | 343 S KIRKWOOD RD STE 205
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City | KIRKWOOD
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State | MO
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Zip | 63122-6195
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Country | US
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Telephone | 314-451-2225
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Fax |
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Provider Business Mailing Address
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Address Line | 343 S KIRKWOOD RD STE 205
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City | KIRKWOOD
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State | MO
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Zip | 63122-6195
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Country | US
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Telephone | 314-451-2225
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | RUSSELL CANTRELL
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Credential | MD
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Telephone | 314-451-2225
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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