Provider Demographics
NPI:1447626759
Name:ELITE PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:ELITE PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:TONKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-848-9188
Mailing Address - Street 1:331 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:LEPANTO
Mailing Address - State:AR
Mailing Address - Zip Code:72354-2202
Mailing Address - Country:US
Mailing Address - Phone:417-848-9188
Mailing Address - Fax:
Practice Address - Street 1:331 W BROAD ST
Practice Address - Street 2:
Practice Address - City:LEPANTO
Practice Address - State:AR
Practice Address - Zip Code:72354-2202
Practice Address - Country:US
Practice Address - Phone:417-848-9188
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-20
Last Update Date:2015-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty