Provider Demographics
NPI:1073784823
Name:PAIN MANAGEMENT MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:STYNOWICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-741-2701
Mailing Address - Street 1:6829 PARKER RD STE A
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63033-5311
Mailing Address - Country:US
Mailing Address - Phone:314-741-2700
Mailing Address - Fax:314-741-2701
Practice Address - Street 1:6829 PARKER RD STE A
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63033-5311
Practice Address - Country:US
Practice Address - Phone:314-741-2700
Practice Address - Fax:314-741-2701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004001665174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty