Physician Groups LC
Organization Active NPI Pain Clinic/Center · Saint Louis, MO
NPI 1508909680 · NPPES record last updated Apr 2, 2008
Key facts
- NPI
- 1508909680
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Pain Clinic/Center 261QP3300X
- Legal business name
- PHYSICIAN GROUPS LC
- Practice address
- 11155 Dunn Rd
Suite 109N
Saint Louis, MO 63136-6150 - Phone
- (314) 653-5450
- NPI assigned
- Feb 15, 2007
- Organization subpart
- No
Authorized official
- Name
- Raymond P Davidson II, MD
- Title
- President
- Phone
- (314) 286-2028
Other NPIs on the same Medicare enrollment 44
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in MO
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040220001157 | MO | Part B Supplier - Clinic/Group Practice | 3072421254 |
Receives reassigned benefits from 611 practitioners 44 other NPIs on this enrollment This NPI is an additional NPI on the enrollment |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Clinic/Center | 261QP3300X | Yes |
Addresses
Primary practice location
11155 Dunn Rd
Suite 109N
Saint Louis, MO 63136-6150
Mailing address
670 Mason Ridge Center Dr
Suite 300
Saint Louis, MO 63141-8573
Phone (314) 996-7644
Other names
- Christian Hospital Pain Management Clinic
Other providers in Saint Louis, MO
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
- Physician Groups LC
All providers in Saint Louis, MO · Pain Clinic/Center in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 2, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.