Organization
INTERVENTIONAL PAIN MANAGEMENT SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MAHENDRA PAL GUNAPOOTI MD (PRESIDENT)
(314) 830-2600
Entity
Organization
Contact information
Practice address
261 DUNN RD, FLORISSANT, MO 63031-7928
(314) 830-2600
(314) 830-2648
Mailing address
PO BOX 650, EDWARDSVILLE, IL 62025-0650
(314) 830-2600
(314) 830-2648
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
036112334
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500000889
—
MO
01
—
6032125
BLUE CROSS BLUE SHIELD
IL
Enumeration date
03/08/2007
Last updated
05/06/2026
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