Provider Demographics
NPI:1710215546
Name:PAIN, SPINE & REHAB, P.A.
Entity type:Organization
Organization Name:PAIN, SPINE & REHAB, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BELL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAZAFINDRABE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:620-792-2991
Mailing Address - Street 1:925 PATTON ROAD
Mailing Address - Street 2:
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 PATTON ROAD
Practice Address - Street 2:
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:2009-12-07
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31344208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1063414605OtherINDIV NPI