Provider Demographics
NPI:1396278941
Name:KANSAS PAIN CARE GROUPLLC
Entity type:Organization
Organization Name:KANSAS PAIN CARE GROUPLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:BRADLEY
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:ECK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:316-201-9358
Mailing Address - Street 1:4817 E DOUGLAS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-1013
Mailing Address - Country:US
Mailing Address - Phone:316-201-9358
Mailing Address - Fax:316-201-9358
Practice Address - Street 1:4817 E DOUGLAS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-1013
Practice Address - Country:US
Practice Address - Phone:316-201-9358
Practice Address - Fax:316-201-9358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-10
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty