Organization Name: | PAIN MANAGEMENT MEDICAL CENTER, LLC |
NPI Number: | 1073784823 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GREGORY A STYNOWICK (PHYSICIAN) |
Mailing Address: | 6829 Parker Rd Ste A Florissant |
State: | MO US |
Postal Code: | 630335312 |
Phone Number: | 3147412700 |
Fax Number: | 3147412701 |
NPI Enumeration Date: | 03/20/2008 |
NPI Last Update Date: | 07/18/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 2004001665 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |