Provider Demographics
NPI:1417973660
Name:MINERAL AREA PAIN CENTER, P.C.
Entity Type:Organization
Organization Name:MINERAL AREA PAIN CENTER, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:W
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:573-756-3400
Mailing Address - Street 1:608 MAPLE VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-1976
Mailing Address - Country:US
Mailing Address - Phone:573-756-3400
Mailing Address - Fax:573-756-0800
Practice Address - Street 1:618 MAPLE VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-1976
Practice Address - Country:US
Practice Address - Phone:573-756-3400
Practice Address - Fax:573-756-0800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO114791OtherBCBS MO GROUP #
MO6702300001Medicare NSC
MO990001455Medicare PIN