Provider Demographics
NPI:1366547333
Name:NORTHWEST KANSAS PAIN & ANESTHESIA, PA
Entity type:Organization
Organization Name:NORTHWEST KANSAS PAIN & ANESTHESIA, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-628-8300
Mailing Address - Street 1:2210 CANTERBURY DR
Mailing Address - Street 2:RESOURCE BUILDING
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601-2370
Mailing Address - Country:US
Mailing Address - Phone:785-628-8300
Mailing Address - Fax:785-623-4634
Practice Address - Street 1:2210 CANTERBURY DR
Practice Address - Street 2:RESOURCE BUILDING
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601-2370
Practice Address - Country:US
Practice Address - Phone:785-628-8300
Practice Address - Fax:785-623-4634
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0424431207L00000X, 207LC0200X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Not Answered207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care MedicineGroup - Multi-Specialty
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS059329OtherBCBS OF KANSAS
KS059329Medicare ID - Type UnspecifiedMCR OF KANSAS
KSF58013Medicare UPIN