Provider Demographics
NPI:1396709127
Name:ROCKHILL PAIN SPECIALISTS PC
Entity type:Organization
Organization Name:ROCKHILL PAIN SPECIALISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:RN MBA
Authorized Official - Phone:913-754-0641
Mailing Address - Street 1:10561 BARKLEY
Mailing Address - Street 2:SUITE 610
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66212-1835
Mailing Address - Country:US
Mailing Address - Phone:913-754-0641
Mailing Address - Fax:913-754-0646
Practice Address - Street 1:6675 HOLMES RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64131
Practice Address - Country:US
Practice Address - Phone:816-276-7094
Practice Address - Fax:816-276-7816
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
2143025OtherUHC
7307424OtherAETNA
KS100426990BMedicaid
CJ2949OtherRR MEDICARE
MO30200017OtherBCBS
MO505811109Medicaid
2143025OtherUHC
KSL470000BMedicare PIN
MO30200017OtherBCBS