Provider Demographics
NPI:1073924833
Name:EUREKA PAIN CLINIC LLC
Entity Type:Organization
Organization Name:EUREKA PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNHIRAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-326-4414
Mailing Address - Street 1:349 TRAILHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:DARDENNE PRAIRIE
Mailing Address - State:MO
Mailing Address - Zip Code:63368-7599
Mailing Address - Country:US
Mailing Address - Phone:636-326-4414
Mailing Address - Fax:
Practice Address - Street 1:54 THE LEGENDS PKWY
Practice Address - Street 2:SUITE 153
Practice Address - City:EUREKA
Practice Address - State:MO
Practice Address - Zip Code:63025-3803
Practice Address - Country:US
Practice Address - Phone:636-326-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-14
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004011002207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty