Healthcare Provider Details

I. General information

NPI: 1144211384
Provider Name (Legal Business Name): KC PAIN CENTERS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 NE MISSOURI RD SUITE 103
LEES SUMMIT MO
64086-4722
US

IV. Provider business mailing address

8717 W 110TH ST SUITE 600
OVERLAND PARK KS
66210-2144
US

V. Phone/Fax

Practice location:
  • Phone: 816-763-1559
  • Fax: 816-965-8404
Mailing address:
  • Phone: 913-428-2900
  • Fax: 913-428-2951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RYAN J. GRINDSTAFF
Title or Position: PRESIDENT
Credential: MD, PHD
Phone: 913-428-2900