Provider Demographics
NPI:1083982037
Name:ADVANCED PAIN MEDICINE ASSOCIATES, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICINE ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:C
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-942-4519
Mailing Address - Street 1:3715 N OLIVER
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67220-3404
Mailing Address - Country:US
Mailing Address - Phone:316-942-4519
Mailing Address - Fax:316-942-4655
Practice Address - Street 1:3715 N OLIVER
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67220-3404
Practice Address - Country:US
Practice Address - Phone:316-942-4519
Practice Address - Fax:316-942-4655
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X, 261QP3300X
KS293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
No293D00000XLaboratoriesPhysiological LaboratoryGroup - Single Specialty