Provider Demographics
NPI:1144211384
Name:KC PAIN CENTERS, LLC
Entity Type:Organization
Organization Name:KC PAIN CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:GRINDSTAFF
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:913-428-2900
Mailing Address - Street 1:8717 W 110TH ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2144
Mailing Address - Country:US
Mailing Address - Phone:913-428-2900
Mailing Address - Fax:913-428-2951
Practice Address - Street 1:200 NE MISSOURI RD
Practice Address - Street 2:SUITE 103
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4722
Practice Address - Country:US
Practice Address - Phone:816-763-1559
Practice Address - Fax:816-965-8404
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ANESTHESIA ASSOCIATES OF KANSAS CITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-11-04
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOCH6776OtherRR MEDICARE KCP
MOCK2816OtherRR MEDICARE
MO509679106Medicaid
MOCR0764OtherRR MEDICARE
MO18971015OtherBCBS
MOH530000OtherMEDICARE
MOCR0764OtherRR MEDICARE