1053499228 NPI number — PINKERTON PAIN THERAPY, LLC

Table of content: (NPI 1053499228)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053499228 NPI number — PINKERTON PAIN THERAPY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PINKERTON PAIN THERAPY, 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:
1053499228
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13000 W 87TH STREET PKWY
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
LENEXA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66215-4634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-981-0830
Provider Business Mailing Address Fax Number:
913-981-0831

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 W 87TH STREET PKWY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LENEXA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66215-4634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-981-0830
Provider Business Practice Location Address Fax Number:
913-981-0831
Provider Enumeration Date:
11/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PINKERTON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
C
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
417-291-4321

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  0431141 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 0431141 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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