Healthcare Provider Details

I. General information

NPI: 1528248291
Provider Name (Legal Business Name): SJ PAIN ASSOCIATES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 CARONDELET DR
KANSAS CITY MO
64114-4673
US

IV. Provider business mailing address

10310 STATE LINE RD SUITE A
LEAWOOD KS
66206-2658
US

V. Phone/Fax

Practice location:
  • Phone: 816-943-3100
  • Fax:
Mailing address:
  • Phone: 913-647-4100
  • Fax: 913-647-4120

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. VINCENT G. JOHNSON
Title or Position: PRESIDENT
Credential: D.O.
Phone: 816-943-3100