Provider Demographics
NPI:1598304917
Name:ELITE PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ELITE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:BOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:417-888-0167
Mailing Address - Street 1:222 E PRIMROSE ST STE E
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-5233
Mailing Address - Country:US
Mailing Address - Phone:417-888-0167
Mailing Address - Fax:417-888-0189
Practice Address - Street 1:5780 OSAGE BEACH PKWY STE 113
Practice Address - Street 2:
Practice Address - City:OSAGE BEACH
Practice Address - State:MO
Practice Address - Zip Code:65065-3188
Practice Address - Country:US
Practice Address - Phone:573-693-9080
Practice Address - Fax:417-888-0189
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-02
Last Update Date:2020-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies