Healthcare Provider Details

I. General information

NPI: 1700134004
Provider Name (Legal Business Name): KANSAS CENTER FOR PAIN RELIEF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/17/2012
Last Update Date: 12/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11413 ASH ST
LEAWOOD KS
66211-1837
US

IV. Provider business mailing address

11413 ASH ST
LEAWOOD KS
66211-1837
US

V. Phone/Fax

Practice location:
  • Phone: 913-663-5533
  • Fax:
Mailing address:
  • Phone: 913-663-5533
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number6643217
License Number StateKS

VIII. Authorized Official

Name: DR. MARK A GREENFIELD
Title or Position: OWNER
Credential: MD
Phone: 913-663-5533