Provider Demographics
NPI:1265614077
Name:MIDWEST PAIN CENTER, LLC.
Entity type:Organization
Organization Name:MIDWEST PAIN CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:636-519-8889
Mailing Address - Street 1:17300 N OUTER 40
Mailing Address - Street 2:STE. 100
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63005-1364
Mailing Address - Country:US
Mailing Address - Phone:636-519-8889
Mailing Address - Fax:636-536-0120
Practice Address - Street 1:17300 N OUTER 40
Practice Address - Street 2:STE. 100
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63005-1364
Practice Address - Country:US
Practice Address - Phone:636-519-8889
Practice Address - Fax:636-536-0120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3N29174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1811988942OtherNPI
MOD87033OtherUPIN
MOD87033OtherUPIN
MO000094855Medicare UPIN