Provider Demographics
NPI:1053499228
Name:PINKERTON PAIN THERAPY, LLC
Entity Type:Organization
Organization Name:PINKERTON PAIN THERAPY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:PINKERTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:417-291-4321
Mailing Address - Street 1:13000 W 87TH STREET PKWY
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LENEXA
Mailing Address - State:KS
Mailing Address - Zip Code:66215-4634
Mailing Address - Country:US
Mailing Address - Phone:913-981-0830
Mailing Address - Fax:913-981-0831
Practice Address - Street 1:13000 W 87TH STREET PKWY
Practice Address - Street 2:SUITE 103
Practice Address - City:LENEXA
Practice Address - State:KS
Practice Address - Zip Code:66215-4634
Practice Address - Country:US
Practice Address - Phone:913-981-0830
Practice Address - Fax:913-981-0831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2017-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431141207L00000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSKA3024Medicare PIN
MO000014733Medicare PIN