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General NPI Number Information
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NPI Number | 1720332810
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Entity Type | Organization
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Legal Business Name | PAIN, SPINE & REHAB.,A.S.C.,P.A.
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Dates
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Enumeration Date | 10/29/2012
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Last Update Date | 10/29/2012
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Provider Practice Location Address
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Address Line | 925 S PATTON RD SUITE B
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City | GREAT BEND
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State | KS
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Zip | 67530-4627
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Country | US
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Telephone | 620-792-2991
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Fax | 620-792-3804
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Provider Business Mailing Address
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Address Line | 925 S PATTON RD SUITE B
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City | GREAT BEND
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State | KS
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Zip | 67530-4627
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Country | US
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Telephone | 620-792-2991
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Fax | 620-792-3804
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Authorized Official
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Title or Position | RESIDENT AGENT
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Name | DR. BELL MANANIRINA RAZAFINDRABE
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Credential | M.D.
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Telephone | 620-792-2991
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 0431344
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License Number State | KS
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