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General NPI Number Information
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NPI Number | 1871245167
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Entity Type | Organization
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Legal Business Name | SEMO PAIN CENTER LLC
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Dates
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Enumeration Date | 01/19/2022
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Last Update Date | 01/19/2022
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Provider Practice Location Address
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Address Line | 907 E REED ST
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City | HAYTI
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State | MO
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Zip | 63851-1242
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Country | US
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Telephone | 573-359-3230
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Fax |
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Provider Business Mailing Address
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Address Line | 2903 W STATE HIGHWAY 84
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City | BRAGG CITY
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State | MO
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Zip | 63827-9673
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. MUHAMMAD ASLAM KHAN
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Credential |
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Telephone | 573-359-4321
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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