Provider Demographics
NPI:1104929546
Name:KANSAS PAIN MANAGEMENT
Entity type:Organization
Organization Name:KANSAS PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MAYANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:913-339-9437
Mailing Address - Street 1:10995 QUIVIRA RD
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1207
Mailing Address - Country:US
Mailing Address - Phone:913-339-9437
Mailing Address - Fax:913-339-9538
Practice Address - Street 1:10995 QUIVIRA RD
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1207
Practice Address - Country:US
Practice Address - Phone:913-339-9437
Practice Address - Fax:913-339-9538
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2022-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100316770AMedicaid
MO503837601Medicaid
KS20694016OtherBLUE CROSS BLUE SHIELD KANSAS CITY-GROUP #
KS111136Medicare PIN