Provider Demographics
NPI:1700134004
Name:KANSAS CENTER FOR PAIN RELIEF, LLC
Entity Type:Organization
Organization Name:KANSAS CENTER FOR PAIN RELIEF, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:GREENFIELD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-663-5533
Mailing Address - Street 1:11413 ASH ST
Mailing Address - Street 2:
Mailing Address - City:LEAWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1837
Mailing Address - Country:US
Mailing Address - Phone:913-663-5533
Mailing Address - Fax:
Practice Address - Street 1:11413 ASH ST
Practice Address - Street 2:
Practice Address - City:LEAWOOD
Practice Address - State:KS
Practice Address - Zip Code:66211-1837
Practice Address - Country:US
Practice Address - Phone:913-663-5533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-17
Last Update Date:2012-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6643217261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty