Provider Demographics
NPI:1285920041
Name:KANSAS CITY PAIN MANAGEMENT PA
Entity type:Organization
Organization Name:KANSAS CITY PAIN MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:R
Authorized Official - Last Name:CONIGLIARO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:913-339-6300
Mailing Address - Street 1:8500 W 110TH ST
Mailing Address - Street 2:SUITE 525
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-1874
Mailing Address - Country:US
Mailing Address - Phone:913-339-6300
Mailing Address - Fax:913-339-6379
Practice Address - Street 1:8500 W 110TH ST
Practice Address - Street 2:SUITE 525
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-1874
Practice Address - Country:US
Practice Address - Phone:913-339-6300
Practice Address - Fax:913-339-6379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS01-04718111N00000X
KS01-04538111N00000X
KS04-29052208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty