Provider Demographics
NPI:1841568144
Name:OCCUPATIONAL AND PAIN MANAGEMENT PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:OCCUPATIONAL AND PAIN MANAGEMENT PROFESSIONALS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:RHONE
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-931-5533
Mailing Address - Street 1:1479A U.S. HIGHWAY 61
Mailing Address - Street 2:
Mailing Address - City:FESTUS
Mailing Address - State:MO
Mailing Address - Zip Code:63028-4123
Mailing Address - Country:US
Mailing Address - Phone:636-931-5533
Mailing Address - Fax:636-931-5502
Practice Address - Street 1:1479A U.S. HIGHWAY 61
Practice Address - Street 2:
Practice Address - City:FESTUS
Practice Address - State:MO
Practice Address - Zip Code:63028-4123
Practice Address - Country:US
Practice Address - Phone:636-931-5533
Practice Address - Fax:636-931-5502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-01
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7H67207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOE38750Medicare UPIN