Provider Demographics
NPI:1427444074
Name:AMERICAN PAIN CLINIC
Entity type:Organization
Organization Name:AMERICAN PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:
Authorized Official - Credentials:DC, MD
Authorized Official - Phone:855-808-7246
Mailing Address - Street 1:10007 KENNERLY RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2179
Mailing Address - Country:US
Mailing Address - Phone:314-270-9634
Mailing Address - Fax:888-241-0474
Practice Address - Street 1:10007 KENNERLY RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63128-2179
Practice Address - Country:US
Practice Address - Phone:314-270-9634
Practice Address - Fax:888-241-0474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-10
Last Update Date:2015-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013036906174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty