| Organization Name: | PAIN MANAGEMENT CENTERS OF ST. LOUIS, INC. |
| NPI Number: | 1013280973 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | MITCHELL LIBERMAN (CEO) |
| Mailing Address: | 8045 Big Bend Blvd Suite 201 Webster Groves |
| State: | MO US |
| Postal Code: | 631192714 |
| Phone Number: | 3143743408 |
| Fax Number: | |
| NPI Enumeration Date: | 02/22/2012 |
| NPI Last Update Date: | 02/22/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 112767 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MO |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |