# KANSAS JOINT & SPINE INSTITUTE

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kansas Joint and Spine Pain Management Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1164742565
- **Authorized official:** DEBBIE BROCK-BAKER (CEO)
- **Authorized official phone:** (316) 858-1900

## Contact information

- **Practice address:** 10100 SHANNON WOODS ST, WICHITA, KS 67226-4103
- **Practice address phone:** (316) 858-1900
- **Practice address fax:** (316) 858-1905
- **Mailing address:** 10100 SHANNON WOODS ST, WICHITA, KS 67226-4103
- **Mailing address phone:** (316) 858-1900
- **Mailing address fax:** (316) 858-1905

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 06/08/2010
- **Last updated:** 11/16/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | KA2539 | MEDICARE PTAN | KS |