Healthcare Provider Details

I. General information

NPI: 1104871540
Provider Name (Legal Business Name): BACK-PAIN CARE CENTERS, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4701 COLLEGE BLVD SUITE 206
LEAWOOD KS
66211-1603
US

IV. Provider business mailing address

4701 COLLEGE BLVD SUITE 206
LEAWOOD KS
66211-1603
US

V. Phone/Fax

Practice location:
  • Phone: 913-888-2225
  • Fax: 913-663-1514
Mailing address:
  • Phone: 913-888-2225
  • Fax: 913-663-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberA24580204
License Number StateKS

VIII. Authorized Official

Name: CARROLL ZAHORSKY
Title or Position: PRESIDENT
Credential: MD
Phone: 913-888-2225