Provider Demographics
NPI:1376149393
Name:ANODYNE OF MANCHESTER, LLC
Entity Type:Organization
Organization Name:ANODYNE OF MANCHESTER, LLC
Other - Org Name:ANODYNE PAIN AND WELLNESS SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-330-7246
Mailing Address - Street 1:1001 BRITTANY PKWY
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MO
Mailing Address - Zip Code:63011-4325
Mailing Address - Country:US
Mailing Address - Phone:636-330-7246
Mailing Address - Fax:
Practice Address - Street 1:1001 BRITTANY PKWY
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MO
Practice Address - Zip Code:63011-4325
Practice Address - Country:US
Practice Address - Phone:636-330-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-06
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical TherapyGroup - Multi-Specialty