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General NPI Number Information
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NPI Number | 1619262615
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Entity Type | Organization
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Legal Business Name | EMPORIA PAIN MANAGEMENT CENTER, LLC
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Dates
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Enumeration Date | 06/17/2011
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Last Update Date | 06/17/2011
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Provider Practice Location Address
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Address Line | 2917 W HIGHWAY 50 STE B
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City | EMPORIA
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State | KS
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Zip | 66801-5140
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Country | US
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Telephone | 620-342-7768
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Fax | 620-343-9904
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Provider Business Mailing Address
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Address Line | 2917 W HIGHWAY 50 STE B
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City | EMPORIA
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State | KS
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Zip | 66801-5140
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Country | US
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Telephone | 620-342-7768
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Fax | 620-343-9904
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL DAVID RILEY
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Credential |
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Telephone | 620-342-7768
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 04-23070
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License Number State | KS
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