BRIDGETON PAIN GROUP – NPI #1114626462
General Practice

A physician who specializes in the general practice of diagnosing, treating, and managing patients with a variety of illnesses and conditions.

Health Care Provider Taxonomy Code for General Practice

BRIDGETON PAIN GROUP is a provider located in BRIDGETON, MO. NPPES has assigned the NPI number 1114626462 to BRIDGETON PAIN GROUP on February 27, 2023. It is a Type-2 NPI, indicating this NPI number is associated with an organization. The primary taxonomy selected by this provider is 208D00000X from the Health Care Provider Taxonomy code set, which is classified as General Practice.

The NPI profile was previously updated about 3 years ago on Oct 30, 2023. Use the NPI data found here to bill health insurance companies, identify providers enrolled in Medicare and Medicaid services or other HIPAA compliant transactions. See the complete NPI profile for BRIDGETON PAIN GROUP below.

NPI Profile for
BRIDGETON PAIN GROUP

NPI Number
1114626462
Enumeration Date

(more than 3 years ago)
Entity Type
Type-2  Organization
Organization health care providers may have a single employee or thousands of employees. An example is an incorporated individual who is an organization's only employee.
Legal Name
BRIDGETON PAIN GROUP
Primary location
11520 SAINT CHARLES ROCK RD STE 201
BRIDGETON, MO 63044
Phone: (314) 526-6093 Fax:
Mailing address
Same as primary location
Organization Subpart
No
Authorized Official
MITCHELL LIBERMAN
PRESIDENT
Phone: (314) 526-6093
Updated
Certification Date
Oct 30, 2023

Note: NPPES allows providers to attest to the accuracy of their NPI data. When a provider request any change to the NPI record, they will be able to attest to their changed NPI data, resulting in an updated certification date.

Taxonomy Code(s)

A taxonomy code is a code that describes the health care service provider's type, classification, and the area of specialization. The primary specialty for this provider is indicated as (Primary) below.

Taxonomy Classification / Specialization State License
208D00000X
- General Practice (Primary)

The taxonomy codes are selected by the provider at the time of NPI registration. Selection of a taxonomy code does not replace any credentialing or validation process that the provider requesting the code should complete.