Provider Demographics
NPI:1083098115
Name:ELITE PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ELITE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ARIES
Authorized Official - Middle Name:E
Authorized Official - Last Name:SPARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-888-0167
Mailing Address - Street 1:222 E PRIMROSE ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5233
Mailing Address - Country:US
Mailing Address - Phone:417-888-0167
Mailing Address - Fax:417-888-0189
Practice Address - Street 1:1601 K66 STE C
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4306
Practice Address - Country:US
Practice Address - Phone:417-553-1404
Practice Address - Fax:417-553-1604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-18
Last Update Date:2019-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty