Provider Demographics
NPI:1710967211
Name:KANSAS PROFESSIONAL ANESTHESIA AND PAIN MANAGEMENT SPECIALISTS, P.A.
Entity Type:Organization
Organization Name:KANSAS PROFESSIONAL ANESTHESIA AND PAIN MANAGEMENT SPECIALISTS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-618-1515
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:#200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-618-1515
Mailing Address - Fax:316-618-8635
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:#200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-618-1515
Practice Address - Fax:316-618-8635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-19
Last Update Date:2014-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
X41628Medicare UPIN
110490Medicare ID - Type Unspecified