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General NPI Number Information
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NPI Number | 1477880581
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Entity Type | Organization
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Legal Business Name | PAIN AND REHABILITATION SPECIALISTS OF ST. LOUIS
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Dates
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Enumeration Date | 11/10/2009
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | 14825 NORTH OUTER 40 SUITE 360
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-336-2750
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Fax | 314-336-2571
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Provider Business Mailing Address
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Address Line | 14825 NORTH OUTER 40 SUITE 360
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City | CHESTERFIELD
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State | MO
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Zip | 63017
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Country | US
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Telephone | 314-336-2750
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Fax | 314-336-2571
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. KAREN O WILSON
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Credential |
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Telephone | 636-219-6634
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 2009025407
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License Number State | MO
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