=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013018076
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN SOURCE SOLUTIONS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/25/2006
-----------------------------------------------------
Last Update Date | 07/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2800 CLAY EDWARDS DR
-----------------------------------------------------
City | NORTH KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64116-3220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-221-4114
-----------------------------------------------------
Fax | 816-471-1247
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 411099
-----------------------------------------------------
City | KANSAS CITY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64141-1099
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-221-5050
-----------------------------------------------------
Fax | 816-471-1247
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROVIDER AUTHORIZED OFFICIAL
-----------------------------------------------------
Name | SEAN CLINEFELTER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 816-221-5050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------