Healthcare Provider Details

I. General information

NPI: 1811933716
Provider Name (Legal Business Name): PAINCARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10501 METCALF AVE
OVERLAND PARK KS
66212-1815
US

IV. Provider business mailing address

10501 METCALF AVE
OVERLAND PARK KS
66212-1815
US

V. Phone/Fax

Practice location:
  • Phone: 913-901-8880
  • Fax: 913-901-8898
Mailing address:
  • Phone: 913-901-8880
  • Fax: 913-901-8898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: KIMBER EUBANKS
Title or Position: MD
Credential:
Phone: 913-901-8880