1033509971 NPI number — INTERVENTIONAL SPINE AND PAIN, LLP

Table of content: (NPI 1033509971)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033509971 NPI number — INTERVENTIONAL SPINE AND PAIN, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL SPINE AND PAIN, LLP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033509971
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12221 MERIT DR STE 620
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-3222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-506-2610
Provider Business Mailing Address Fax Number:
972-681-8727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17051 NORTH DALLAS PARKWAY
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-506-2610
Provider Business Practice Location Address Fax Number:
214-506-1170
Provider Enumeration Date:
01/30/2015

Additional Information

Authorized Official

Authorized Official Last Name:
ZEBALLOS
Authorized Official First Name:
PABLO
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-506-2610

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 193400000X . This is a "TAXONOMY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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