Provider Demographics
NPI:1316225543
Name:WICHITA PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:WICHITA PAIN MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:TODD
Authorized Official - Middle Name:H
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-722-4776
Mailing Address - Street 1:2260 N RIDGE RD
Mailing Address - Street 2:ST. 100
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-1132
Mailing Address - Country:US
Mailing Address - Phone:316-722-4776
Mailing Address - Fax:316-722-4082
Practice Address - Street 1:2260 N RIDGE RD
Practice Address - Street 2:ST. 100
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-1132
Practice Address - Country:US
Practice Address - Phone:316-722-4776
Practice Address - Fax:316-722-4082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-21
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty