Provider Demographics
NPI:1174632673
Name:PAI CLINIC P A
Entity Type:Organization
Organization Name:PAI CLINIC P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:V
Authorized Official - Middle Name:S
Authorized Official - Last Name:PAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-421-0080
Mailing Address - Street 1:1902 S US HIGHWAY 59
Mailing Address - Street 2:
Mailing Address - City:PARSONS
Mailing Address - State:KS
Mailing Address - Zip Code:67357-4948
Mailing Address - Country:US
Mailing Address - Phone:620-421-0080
Mailing Address - Fax:620-421-1578
Practice Address - Street 1:1902 S US HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:PARSONS
Practice Address - State:KS
Practice Address - Zip Code:67357-4948
Practice Address - Country:US
Practice Address - Phone:620-421-0080
Practice Address - Fax:620-421-1578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS16734174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111007Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER