Provider Demographics
NPI:1972651578
Name:ADVANCED PAIN SPECIALISTS, INC.
Entity Type:Organization
Organization Name:ADVANCED PAIN SPECIALISTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:P
Authorized Official - Last Name:CREIGHTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-966-9162
Mailing Address - Street 1:7510 BIG BEND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2104
Mailing Address - Country:US
Mailing Address - Phone:314-647-3855
Mailing Address - Fax:314-647-1964
Practice Address - Street 1:7510 BIG BEND BLVD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2104
Practice Address - Country:US
Practice Address - Phone:314-647-3855
Practice Address - Fax:314-647-1964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMO110005207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MODA5185OtherMEDICARE RR
MO204786107Medicaid
MO000013641Medicare PIN