Provider Demographics
NPI:1043612450
Name:ADVANCED PAIN MANAGEMENT
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT
Other - Org Name:NATIONAL MEDICAL BILLING SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:UNDERWOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-273-6711
Mailing Address - Street 1:16759 MAIN ST
Mailing Address - Street 2:SUITE 220
Mailing Address - City:GROVER
Mailing Address - State:MO
Mailing Address - Zip Code:63040-1232
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:16759 MAIN ST
Practice Address - Street 2:SUITE 220
Practice Address - City:GROVER
Practice Address - State:MO
Practice Address - Zip Code:63040-1232
Practice Address - Country:US
Practice Address - Phone:636-273-6711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-17
Last Update Date:2014-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center