Healthcare Provider Details

I. General information

NPI: 1366547333
Provider Name (Legal Business Name): NORTHWEST KANSAS PAIN & ANESTHESIA, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2210 CANTERBURY DR RESOURCE BUILDING
HAYS KS
67601-2370
US

IV. Provider business mailing address

2210 CANTERBURY DR RESOURCE BUILDING
HAYS KS
67601-2370
US

V. Phone/Fax

Practice location:
  • Phone: 785-628-8300
  • Fax: 785-623-4634
Mailing address:
  • Phone: 785-628-8300
  • Fax: 785-623-4634

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0424431
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number0424431
License Number StateKS
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number0424431
License Number StateKS

VIII. Authorized Official

Name: DR. KEITH GREEN
Title or Position: DOCTOR/OWNER
Credential: MD
Phone: 785-628-8300