Provider Demographics
NPI:1942516463
Name:WESTPORT PLAZA PAIN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:WESTPORT PLAZA PAIN MANAGEMENT, INC.
Other - Org Name:KC WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:T
Authorized Official - Last Name:BRITTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-694-1658
Mailing Address - Street 1:3408 RAINBOW EXT
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66103-2081
Mailing Address - Country:US
Mailing Address - Phone:816-694-1658
Mailing Address - Fax:816-841-4801
Practice Address - Street 1:3408 RAINBOW EXT
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66103-2081
Practice Address - Country:US
Practice Address - Phone:816-694-1658
Practice Address - Fax:816-841-4801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-20
Last Update Date:2016-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty