Provider Demographics
NPI:1679115919
Name:HOLISTIC PAIN MANAGEMENT OF KANSAS, LLC
Entity Type:Organization
Organization Name:HOLISTIC PAIN MANAGEMENT OF KANSAS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEDD
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:307-271-2332
Mailing Address - Street 1:3780 N GARFIELD AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538
Mailing Address - Country:US
Mailing Address - Phone:307-250-4953
Mailing Address - Fax:833-923-2295
Practice Address - Street 1:1310 WESTLOOP PL # 198
Practice Address - Street 2:
Practice Address - City:MANHATTAN
Practice Address - State:KS
Practice Address - Zip Code:66502-2842
Practice Address - Country:US
Practice Address - Phone:307-271-2332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty