1295370419 NPI number — INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC

Table of content: (NPI 1295370419)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295370419 NPI number — INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC
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:
6
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:
1295370419
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7145 E VIRGINIA ST STE 2000
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47715-9147
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-962-7894
Provider Business Mailing Address Fax Number:
812-476-6162

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7145 E VIRGINIA ST STE 1000
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47715-9147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-476-6166
Provider Business Practice Location Address Fax Number:
812-476-6162
Provider Enumeration Date:
11/12/2019

Additional Information

Authorized Official

Authorized Official Last Name:
FISHER
Authorized Official First Name:
TAMIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING SPECIALIST
Authorized Official Telephone Number:
812-962-7894

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 15D2192364 . This is a "CLIA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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