Provider Demographics
NPI:1093828584
Name:COLUMBIA INTERVENTIONAL PAIN CENTER LLP
Entity type:Organization
Organization Name:COLUMBIA INTERVENTIONAL PAIN CENTER LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JULIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MESTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-442-2299
Mailing Address - Street 1:PO BOX 7237
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7237
Mailing Address - Country:US
Mailing Address - Phone:573-468-6501
Mailing Address - Fax:573-468-6502
Practice Address - Street 1:305 N KEENE ST
Practice Address - Street 2:SUITE #105
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6897
Practice Address - Country:US
Practice Address - Phone:573-442-2299
Practice Address - Fax:573-442-3196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-17
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO507608008Medicaid
MO507608008Medicaid