Healthcare Provider Details

I. General information

NPI: 1053499228
Provider Name (Legal Business Name): PINKERTON PAIN THERAPY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 03/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13000 W 87TH STREET PKWY SUITE 103
LENEXA KS
66215-4634
US

IV. Provider business mailing address

13000 W 87TH STREET PKWY SUITE 103
LENEXA KS
66215-4634
US

V. Phone/Fax

Practice location:
  • Phone: 913-981-0830
  • Fax: 913-981-0831
Mailing address:
  • Phone: 913-981-0830
  • Fax: 913-981-0831

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number0431141
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number0431141
License Number StateKS

VIII. Authorized Official

Name: DR. MARK C PINKERTON
Title or Position: OFFICE MANAGER
Credential: MD
Phone: 417-291-4321