Healthcare Provider Details

I. General information

NPI: 1083982037
Provider Name (Legal Business Name): ADVANCED PAIN MEDICINE ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2011
Last Update Date: 11/11/2022
Certification Date: 11/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3715 N OLIVER
WICHITA KS
67220-3404
US

IV. Provider business mailing address

3715 N OLIVER
WICHITA KS
67220-3404
US

V. Phone/Fax

Practice location:
  • Phone: 316-942-4519
  • Fax: 316-942-4655
Mailing address:
  • Phone: 316-942-4519
  • Fax: 316-942-4655

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code293D00000X
TaxonomyPhysiological Laboratory
License Number
License Number StateKS

VIII. Authorized Official

Name: DR. JON C PARKS
Title or Position: PRESIDENT
Credential: M.D
Phone: 316-942-4519