Organization
ELPIS PAIN MANAGEMENT CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VIVEK K MANCHANDA M.D. (PRESIDENT)
(636) 329-9077
Entity
Organization
Contact information
Practice address
4122 KEATON CROSSING BLVD, SUITE 102, O FALLON, MO 63368-8218
(636) 329-9077
Mailing address
4122 KEATON CROSSING BLVD, SUITE 102, O FALLON, MO 63368-8218
(636) 329-9077
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
2006017511
MO
208VP0000X
Pain Medicine Physician
Primary
2006017511
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083729941
—
MO
01
—
431560263
TRICARE WEST
MO
01
—
7233350001
NORIDIAN , MEDICARE DME
MO
01
—
DV4098
RAILROAD MEDICARE GROUP PTAN
MO
01
—
P00836305
RAILROAD MEDICARE
MO
Enumeration date
11/07/2012
Last updated
04/26/2015
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