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General NPI Number Information
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NPI Number | 1487980660
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Entity Type | Organization
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Legal Business Name | PROFESSIONAL PHYSICIANS PAIN SERVICES, LLC
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Dates
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Enumeration Date | 10/23/2009
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Last Update Date | 11/16/2009
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Provider Practice Location Address
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Address Line | 10012 KENNERLY RD SUITE 404
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City | SAINT LOUIS
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State | MO
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Zip | 63128-2197
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Country | US
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Telephone | 314-729-7100
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Fax | 314-729-0292
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Provider Business Mailing Address
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Address Line | PO BOX 31434
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City | SAINT LOUIS
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State | MO
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Zip | 63131-0434
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Country | US
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Telephone | 314-729-7100
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Fax | 314-729-0292
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Authorized Official
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Title or Position | PARTNER
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Name | DR. MICHAEL SCOTT BOEDEFELD
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Credential | M.D.
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Telephone | 314-729-7100
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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 | MO
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