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General NPI Number Information
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NPI Number | 1467186411
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Entity Type | Organization
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Legal Business Name | ADVANCED PAIN RELIEF CENTER LLC
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Dates
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Enumeration Date | 07/14/2022
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Last Update Date | 07/29/2022
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Provider Practice Location Address
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Address Line | 4710 MEXICO RD STE B
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City | SAINT PETERS
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State | MO
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Zip | 63376-1663
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Country | US
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Telephone | 636-244-0124
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Fax |
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Provider Business Mailing Address
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Address Line | 4710 MEXICO RD STE B
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City | SAINT PETERS
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State | MO
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Zip | 63376-1663
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Country | US
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Telephone | 636-244-0124
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANDREW MORNINGSTAR
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Credential |
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Telephone | 618-741-0786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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