Provider Demographics
NPI:1700489267
Name:INTEGRITY REGIONAL PAIN CENTER LLC
Entity Type:Organization
Organization Name:INTEGRITY REGIONAL PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMI
Authorized Official - Middle Name:
Authorized Official - Last Name:POLITTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-735-1608
Mailing Address - Street 1:PO BOX 585
Mailing Address - Street 2:
Mailing Address - City:DE SOTO
Mailing Address - State:MO
Mailing Address - Zip Code:63020-0585
Mailing Address - Country:US
Mailing Address - Phone:636-735-1608
Mailing Address - Fax:636-337-5418
Practice Address - Street 1:2865 JAMES BLVD
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2803
Practice Address - Country:US
Practice Address - Phone:636-735-1608
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-18
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty