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General NPI Number Information
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NPI Number | 1407388739
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Entity Type | Organization
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Legal Business Name | KANSAS PAIN AND WELLNESS LLC
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Dates
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Enumeration Date | 03/28/2017
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Last Update Date | 01/07/2020
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Provider Practice Location Address
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Address Line | 715 SOUTHWIND DR
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City | JUNCTION CITY
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State | KS
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Zip | 66441-9021
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Country | US
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Telephone | 785-530-5505
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Fax | 785-530-6885
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Provider Business Mailing Address
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Address Line | 715 SOUTHWIND DR
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City | JUNCTION CITY
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State | KS
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Zip | 66441-9021
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Country | US
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Telephone | 785-530-5505
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Fax | 785-530-6885
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHRISTOPHER L SOUTHWICK
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Credential | MD
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Telephone | 785-530-5505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | 4301095882
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License Number State | KS
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