Provider Demographics
NPI:1477880581
Name:PAIN AND REHABILITATION SPECIALISTS OF ST. LOUIS
Entity Type:Organization
Organization Name:PAIN AND REHABILITATION SPECIALISTS OF ST. LOUIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:O
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-219-6634
Mailing Address - Street 1:14825 NORTH OUTER 40
Mailing Address - Street 2:SUITE 360
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017
Mailing Address - Country:US
Mailing Address - Phone:314-336-2750
Mailing Address - Fax:314-336-2571
Practice Address - Street 1:14825 NORTH OUTER 40
Practice Address - Street 2:SUITE 360
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017
Practice Address - Country:US
Practice Address - Phone:314-336-2750
Practice Address - Fax:314-336-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009025407261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty