Healthcare Provider Details

I. General information

NPI: 1366524076
Provider Name (Legal Business Name): PATRICK D GRIFFITH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 CLAY EDWARDS DR
NORTH KANSAS CITY MO
64116-3220
US

IV. Provider business mailing address

PAIN SOURCE SOLUTIONS LLC PO BOX 7391
NORTH KANSAS CITY MO
64116
US

V. Phone/Fax

Practice location:
  • Phone: 816-221-4114
  • Fax: 816-471-1247
Mailing address:
  • Phone: 816-221-5050
  • Fax: 816-471-1247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberR4N50
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberR4N50
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: