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General NPI Number Information
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NPI Number | 1831468446
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT REHABILITATION LLC
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Dates
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Enumeration Date | 12/28/2011
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Last Update Date | 01/09/2012
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Provider Practice Location Address
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Address Line | 103 CHURCH ST
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-294-6322
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Fax | 636-294-6323
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Provider Business Mailing Address
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Address Line | 103 CHURCH ST
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City | O FALLON
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State | MO
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Zip | 63366-2894
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Country | US
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Telephone | 636-294-6322
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Fax | 636-294-6323
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. DALE JOSEPH KLEIN
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Credential | M.D.
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Telephone | 636-294-6322
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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 | 2006031936
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License Number State | MO
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