Provider Demographics
NPI:1881031235
Name:KEARNEY PAIN TREATMENT CENTER, LLC
Entity Type:Organization
Organization Name:KEARNEY PAIN TREATMENT CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DARIAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:083-455-3091
Mailing Address - Street 1:920 E 56TH ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:KEARNEY
Mailing Address - State:NE
Mailing Address - Zip Code:68847-8628
Mailing Address - Country:US
Mailing Address - Phone:308-236-7470
Mailing Address - Fax:
Practice Address - Street 1:920 E 56TH ST
Practice Address - Street 2:SUITE D
Practice Address - City:KEARNEY
Practice Address - State:NE
Practice Address - Zip Code:68847-8628
Practice Address - Country:US
Practice Address - Phone:308-236-7470
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-24
Last Update Date:2020-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical