Provider Demographics
NPI:1184102485
Name:KC PAIN CARE GROUP LLC
Entity type:Organization
Organization Name:KC PAIN CARE GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:APRN
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON-MANFREDI
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:918-808-5328
Mailing Address - Street 1:11233 NALL AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1638
Mailing Address - Country:US
Mailing Address - Phone:918-808-5328
Mailing Address - Fax:
Practice Address - Street 1:11233 NALL AVE STE 100
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1638
Practice Address - Country:US
Practice Address - Phone:918-808-5328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty