MEDICARE: MIDWEST PAIN MANAGEMENT CENTER PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician
2	207L00000X	Anesthesiology Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CE9378	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110311	OTHER	KS	BCBS

General Provider Information

NPI Number	:	1396712485
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIDWEST PAIN MANAGEMENT CENTER PA

Provider Business Mailing Address
First Line	:	PO BOX 3148
Second Line	:
City	:	WICHITA
State	:	KS
Zip	:	67201-3148
Country	:	US
Telephone Number	:	316-685-3698
Fax Number	:

Provider Business Practice Location Address
First Line	:	1708 E 23RD AVE
Second Line	:
City	:	HUTCHINSON
State	:	KS
Zip	:	67502-1114
Country	:	US
Telephone Number	:	620-665-2000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DOUGLAS FRIESEN
Credential	:	MD
Telephone Number	:	620-665-2000

Provider Enumeration Date	:	03/07/2006
Last Update Date	:	09/11/2025

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Directions to “MIDWEST PAIN MANAGEMENT CENTER PA ” Practice Location

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