Provider Demographics
NPI:1891200895
Name:INSTITUTE OF PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:INSTITUTE OF PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATSY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:314-485-5845
Mailing Address - Street 1:10199 WOODFIELD LN
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63132-2922
Mailing Address - Country:US
Mailing Address - Phone:314-485-5845
Mailing Address - Fax:
Practice Address - Street 1:10199 WOODFIELD LN
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63132-2922
Practice Address - Country:US
Practice Address - Phone:314-485-5845
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-12
Last Update Date:2017-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty