Provider Demographics
NPI:1457521189
Name:PAIN RELIEF ASSOCIATES LLC
Entity type:Organization
Organization Name:PAIN RELIEF ASSOCIATES LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:WISE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-946-0799
Mailing Address - Street 1:PO BOX 790126
Mailing Address - Street 2:DEPT 10203
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63179-0126
Mailing Address - Country:US
Mailing Address - Phone:636-600-1137
Mailing Address - Fax:636-600-0412
Practice Address - Street 1:190 SPRING DR
Practice Address - Street 2:
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63303-3255
Practice Address - Country:US
Practice Address - Phone:636-946-0799
Practice Address - Fax:636-946-3166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOPENDINGMedicare Oscar/Certification
MO6205710001Medicare NSC