Provider Demographics
NPI:1992587968
Name:ST LOUIS PAIN CENTER LLC
Entity type:Organization
Organization Name:ST LOUIS PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:MORNINSTAR
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:314-846-2100
Mailing Address - Street 1:5682 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63129-4243
Mailing Address - Country:US
Mailing Address - Phone:314-846-2100
Mailing Address - Fax:314-846-4975
Practice Address - Street 1:5682 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63129-4243
Practice Address - Country:US
Practice Address - Phone:314-846-2100
Practice Address - Fax:314-846-4975
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-16
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202D00000XAllopathic & Osteopathic PhysiciansIntegrative MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty