Provider Demographics
NPI:1396712485
Name:MIDWEST PAIN MANAGEMENT CENTER PA
Entity type:Organization
Organization Name:MIDWEST PAIN MANAGEMENT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FRIESEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-665-2000
Mailing Address - Street 1:PO BOX 3148
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67201-3148
Mailing Address - Country:US
Mailing Address - Phone:316-685-3698
Mailing Address - Fax:
Practice Address - Street 1:1708 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1114
Practice Address - Country:US
Practice Address - Phone:620-665-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS110311OtherBCBS
CE9378OtherRAILROAD MEDICARE
CE9378OtherRAILROAD MEDICARE
KS110311OtherBCBS