Healthcare Provider Details

I. General information

NPI: 1386480341
Provider Name (Legal Business Name): PAINLAB LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2024
Last Update Date: 07/08/2024
Certification Date: 07/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15545 W 87TH ST
LENEXA KS
66219-1434
US

IV. Provider business mailing address

15545 W 87TH ST
LENEXA KS
66219-1434
US

V. Phone/Fax

Practice location:
  • Phone: 883-724-6522
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: STEVE SANBORN
Title or Position: OWNER
Credential:
Phone: 816-337-8558