Provider Demographics
NPI:1578673414
Name:PAIN TREATMENT ASSOCIATES LLC
Entity Type:Organization
Organization Name:PAIN TREATMENT ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:SHAWN
Authorized Official - Last Name:BRASSFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-256-2225
Mailing Address - Street 1:1410 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4754
Mailing Address - Country:US
Mailing Address - Phone:417-256-2225
Mailing Address - Fax:417-256-2373
Practice Address - Street 1:1410 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4754
Practice Address - Country:US
Practice Address - Phone:417-256-2225
Practice Address - Fax:417-256-2373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD 102941207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO501035208Medicaid
MO501035208Medicaid