1144211384 NPI number — KC PAIN CENTERS, LLC

Table of content: (NPI 1144211384)

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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