Provider Demographics
NPI:1124410477
Name:PAIN MANAGMENT MEDICAL GROUP INC
Entity type:Organization
Organization Name:PAIN MANAGMENT MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VIVIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:PINEDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-319-7601
Mailing Address - Street 1:4301 MAIN ST # 205
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-7701
Mailing Address - Country:US
Mailing Address - Phone:816-319-7601
Mailing Address - Fax:816-319-7602
Practice Address - Street 1:4301 MAIN ST # 205
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-7701
Practice Address - Country:US
Practice Address - Phone:816-319-7601
Practice Address - Fax:816-319-7602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-24
Last Update Date:2015-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service