Provider Demographics
NPI:1609257773
Name:ELITE PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ELITE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TONKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-720-4991
Mailing Address - Street 1:1230 E KINGSLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-7231
Mailing Address - Country:US
Mailing Address - Phone:417-553-1080
Mailing Address - Fax:888-472-5145
Practice Address - Street 1:1230 E KINGSLEY ST STE C
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-7231
Practice Address - Country:US
Practice Address - Phone:417-553-1080
Practice Address - Fax:888-472-5145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-15
Last Update Date:2023-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081P2900X
MO332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2007017247OtherMISSOURI MEDICAL LICENSE
MO7422650001OtherNATIONAL SUPPLIER CLEARING HOUSE MEDICARE DMEPOS
MOFT3614307OtherMISSOURI DEA LICENSE
KSFT5221510OtherKANSAS DEA LICENSE