Provider Demographics
NPI:1619262615
Name:EMPORIA PAIN MANAGEMENT CENTER, LLC
Entity Type:Organization
Organization Name:EMPORIA PAIN MANAGEMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-342-7768
Mailing Address - Street 1:2917 W HIGHWAY 50
Mailing Address - Street 2:STE B
Mailing Address - City:EMPORIA
Mailing Address - State:KS
Mailing Address - Zip Code:66801-5140
Mailing Address - Country:US
Mailing Address - Phone:620-342-7768
Mailing Address - Fax:620-343-9904
Practice Address - Street 1:2917 W HIGHWAY 50
Practice Address - Street 2:STE B
Practice Address - City:EMPORIA
Practice Address - State:KS
Practice Address - Zip Code:66801-5140
Practice Address - Country:US
Practice Address - Phone:620-342-7768
Practice Address - Fax:620-343-9904
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-23070261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty