MEDICARE: ST. LOUIS CENTERS FOR PAIN MANAGEMENT, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	112767	MO
2	208D00000X	General Practice Physician	112767	MO

General Provider Information

NPI Number	:	1821434242
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ST. LOUIS CENTERS FOR PAIN MANAGEMENT, LLC

Provider Business Mailing Address
First Line	:	200 N 7TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-2305
Country	:	US
Telephone Number	:	314-262-6755
Fax Number	:	314-261-5043

Provider Business Practice Location Address
First Line	:	200 N 7TH ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63101-2305
Country	:	US
Telephone Number	:	314-262-6755
Fax Number	:	314-261-5043

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MITCHELL LIBERMAN
Credential	:	DC
Telephone Number	:	314-262-6755

Provider Enumeration Date	:	05/13/2013
Last Update Date	:	05/13/2013

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