Basic Information
| Provider Information | |||||||||
| NPI: | 1558611426 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. LOUIS PAIN CONSULTANTS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7750 MARYLAND AVE UNIT 16829 | ||||||||
| Address2: | P.O. BOX 16829 | ||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631055556 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142056149 | ||||||||
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| Practice Location | |||||||||
| Address1: | 121 SAINT LUKES CENTER DR | ||||||||
| Address2: | 403 | ||||||||
| City: | CHESTERFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630173509 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3142056149 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/18/2012 | ||||||||
| LastUpdateDate: | 08/13/2021 | ||||||||
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| AuthorizedOfficialLastName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialFirstName: | ANNE | ||||||||
| AuthorizedOfficialMiddleName: | THERESE | ||||||||
| AuthorizedOfficialTitleorPosition: | SOLE PROPRIETOR | ||||||||
| AuthorizedOfficialTelephone: | 3142056149 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | IV | ||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 08/13/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | 2006026937 | MO | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.