Provider Demographics
NPI:1225673874
Name:PAIN AT FHO LLC
Entity Type:Organization
Organization Name:PAIN AT FHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GERARD
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBRODO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-452-5113
Mailing Address - Street 1:700 W CENTRAL AVE STE 206
Mailing Address - Street 2:
Mailing Address - City:EL DORADO
Mailing Address - State:KS
Mailing Address - Zip Code:67042-2186
Mailing Address - Country:US
Mailing Address - Phone:316-452-5113
Mailing Address - Fax:316-452-5171
Practice Address - Street 1:700 W CENTRAL AVE STE 206
Practice Address - Street 2:
Practice Address - City:EL DORADO
Practice Address - State:KS
Practice Address - Zip Code:67042-2186
Practice Address - Country:US
Practice Address - Phone:316-452-5113
Practice Address - Fax:316-452-5171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-07
Last Update Date:2022-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty