Provider Demographics
NPI:1720332810
Name:PAIN, SPINE & REHAB.,A.S.C.,P.A.
Entity Type:Organization
Organization Name:PAIN, SPINE & REHAB.,A.S.C.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RESIDENT AGENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BELL
Authorized Official - Middle Name:MANANIRINA
Authorized Official - Last Name:RAZAFINDRABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-792-2991
Mailing Address - Street 1:925 S PATTON RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-4627
Mailing Address - Country:US
Mailing Address - Phone:620-792-2991
Mailing Address - Fax:620-792-3804
Practice Address - Street 1:925 S PATTON RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-4627
Practice Address - Country:US
Practice Address - Phone:620-792-2991
Practice Address - Fax:620-792-3804
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-29
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0431344261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200354350CMedicaid