Provider Demographics
NPI:1194159962
Name:PAIN AND REHABILITATION SPECIALISTS, LLC
Entity type:Organization
Organization Name:PAIN AND REHABILITATION SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:
Authorized Official - Last Name:BODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-336-2570
Mailing Address - Street 1:14825 N OUTER 40 RD
Mailing Address - Street 2:SUITE 365
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2152
Mailing Address - Country:US
Mailing Address - Phone:314-336-2570
Mailing Address - Fax:314-336-2571
Practice Address - Street 1:14825 N OUTER 40 RD
Practice Address - Street 2:SUITE 365
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2152
Practice Address - Country:US
Practice Address - Phone:314-336-2570
Practice Address - Fax:314-336-2571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-28
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty