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General NPI Number Information
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NPI Number | 1649565961
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Entity Type | Organization
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Legal Business Name | MISSOURI SPINE ASSOCIATES, LLC
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Dates
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Enumeration Date | 06/15/2011
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Last Update Date | 11/15/2016
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Provider Practice Location Address
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Address Line | 1765 JEFFCO BLVD
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City | ARNOLD
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State | MO
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Zip | 63010-2713
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Country | US
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Telephone | 636-333-3700
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Fax | 636-333-3701
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Provider Business Mailing Address
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Address Line | 1765 JEFFCO BLVD
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City | ARNOLD
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State | MO
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Zip | 63010-2713
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Country | US
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Telephone | 636-333-3700
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Fax | 636-333-3701
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Authorized Official
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Title or Position | OWNER
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Name | ABIRAMI ELANGOVAN
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Credential |
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Telephone | 636-333-3700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 2006037124
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License Number State | MO
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