Provider Demographics
NPI:1437690336
Name:MISSOURI PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:MISSOURI PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS KULA
Authorized Official - Last Name:CRAGG
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-378-2085
Mailing Address - Street 1:8045 BIG BEND BLVD
Mailing Address - Street 2:STE 107
Mailing Address - City:WEBSTER GROVES
Mailing Address - State:MO
Mailing Address - Zip Code:63119
Mailing Address - Country:US
Mailing Address - Phone:314-961-7181
Mailing Address - Fax:314-961-6323
Practice Address - Street 1:12607 OLIVE BLVD
Practice Address - Street 2:
Practice Address - City:CREVE COEUR
Practice Address - State:MO
Practice Address - Zip Code:63141
Practice Address - Country:US
Practice Address - Phone:314-327-8070
Practice Address - Fax:314-228-1891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty