Provider Demographics
NPI:1538584594
Name:AMERICAN PAIN INSTITUTE, LLC
Entity type:Organization
Organization Name:AMERICAN PAIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OF STAFF
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:DALE
Authorized Official - Last Name:LEECH
Authorized Official - Suffix:JR
Authorized Official - Credentials:DC
Authorized Official - Phone:314-972-3107
Mailing Address - Street 1:2730 S SAINT PETERS PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAINT PETERS
Mailing Address - State:MO
Mailing Address - Zip Code:63303-5677
Mailing Address - Country:US
Mailing Address - Phone:314-972-3107
Mailing Address - Fax:
Practice Address - Street 1:2730 S SAINT PETERS PKWY
Practice Address - Street 2:SUITE 104
Practice Address - City:SAINT PETERS
Practice Address - State:MO
Practice Address - Zip Code:63303-5677
Practice Address - Country:US
Practice Address - Phone:314-972-3107
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-27
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO713780001332B00000X
2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty