Provider Demographics
NPI:1609310572
Name:KANSAS REGENERATIVE AND PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:KANSAS REGENERATIVE AND PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:CHANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-618-8305
Mailing Address - Street 1:PO BOX 388
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-0388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3223 N WEBB ROAD
Practice Address - Street 2:SUITE 5
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67226-8176
Practice Address - Country:US
Practice Address - Phone:316-618-8305
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-13
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty