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General NPI Number Information
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NPI Number | 1700489267
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Entity Type | Organization
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Legal Business Name | INTEGRITY REGIONAL PAIN CENTER LLC
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Dates
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Enumeration Date | 11/18/2020
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Last Update Date | 12/01/2020
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Provider Practice Location Address
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Address Line | 2865 JAMES BLVD
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City | POPLAR BLUFF
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State | MO
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Zip | 63901-2803
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Country | US
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Telephone | 636-735-1608
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 585
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City | DE SOTO
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State | MO
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Zip | 63020-0585
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Country | US
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Telephone | 636-735-1608
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Fax | 636-337-5418
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Authorized Official
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Title or Position | OWNER
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Name | AMI POLITTE
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Credential |
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Telephone | 636-735-1608
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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 |
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