1144211384 NPI number — KC PAIN CENTERS, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144211384 NPI number — KC PAIN CENTERS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KC PAIN CENTERS, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144211384
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8717 W 110TH ST
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
OVERLAND PARK
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66210-2144
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-428-2900
Provider Business Mailing Address Fax Number:
913-428-2951

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 NE MISSOURI RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LEES SUMMIT
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64086-4722
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-763-1559
Provider Business Practice Location Address Fax Number:
816-965-8404
Provider Enumeration Date:
11/04/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GRINDSTAFF
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
913-428-2900

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CH6776 . This is a "RR MEDICARE KCP" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: CK2816 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 509679106 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: CR0764 . This is a "RR MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 18971015 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: H530000 . This is a "MEDICARE" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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