Basic Information
| Provider Information | |||||||||
| NPI: | 1639545940 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ELITE PAIN MANAGEMENT, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 222 E PRIMROSE ST STE E | ||||||||
| Address2: | |||||||||
| City: | SPRINGFIELD | ||||||||
| State: | MO | ||||||||
| PostalCode: | 658075233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4178880167 | ||||||||
| FaxNumber: | 4178880189 | ||||||||
| Practice Location | |||||||||
| Address1: | 7150 W SUNSET RD STE 202 | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891131981 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7025141411 | ||||||||
| FaxNumber: | 7025141413 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/20/2015 | ||||||||
| LastUpdateDate: | 09/18/2019 | ||||||||
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| AuthorizedOfficialLastName: | TONKIN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4178489188 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.