MEDICARE: HEARTLAND INTERVENTIONAL PAIN AND SPINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0000X	Pain Medicine Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1518753292
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HEARTLAND INTERVENTIONAL PAIN AND SPINE

Provider Business Mailing Address
First Line	:	2450 N WOODLAWN BLVD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-3902
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2450 N WOODLAWN BLVD
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67220-3902
Country	:	US
Telephone Number	:	405-227-7479
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	BRIAN GOENTZEL
Credential	:	MD
Telephone Number	:	405-227-7479

Provider Enumeration Date	:	04/17/2025
Last Update Date	:	03/09/2026

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Directions to “HEARTLAND INTERVENTIONAL PAIN AND SPINE ” Practice Location

Language	Start Address	Practice Location

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