| Bridgeton Pain Group | |
|
11520 Saint Charles Rock Rd Ste 201 Bridgeton MO 63044 | |
| (314) 526-6093 | |
| Not Available |
| Full Name | Bridgeton Pain Group |
|---|---|
| Speciality | General Practice |
| Location | 11520 Saint Charles Rock Rd Ste 201, Bridgeton, Missouri |
| Authorized Official Name and Position | Mitchell Liberman (PRESIDENT) |
| Authorized Official Contact | 3145266093 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bridgeton Pain Group 11520 Saint Charles Rock Rd Ste 201 Bridgeton MO 63044-2732 Ph: (314) 526-6093 | Bridgeton Pain Group 11520 Saint Charles Rock Rd Ste 201 Bridgeton MO 63044 Ph: (314) 526-6093 |
| NPI Number | 1114626462 |
|---|---|
| Provider Enumeration Date | 02/27/2023 |
| Last Update Date | 10/30/2023 |
| Medicare PECOS PAC ID | 6901259167 |
|---|---|
| Medicare Enrollment ID | O20240124003280 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114626462 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Subrahmanyam Vadlamani |
|---|---|
| Provider Type | Practitioner - General Surgery |
| Provider Identifiers | NPI Number: 1558355214 PECOS PAC ID: 3072550466 Enrollment ID: I20050418000229 |
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