Healthcare Provider Details

I. General information

NPI: 1134677479
Provider Name (Legal Business Name): CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2016
Last Update Date: 06/03/2021
Certification Date: 06/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 SANDHILL DR STE 203
MIDDLETOWN DE
19709-5859
US

IV. Provider business mailing address

223 WILMINGTON W CHESTER PIKE STE 214
CHADDS FORD PA
19317-9007
US

V. Phone/Fax

Practice location:
  • Phone: 302-477-1706
  • Fax: 302-477-1708
Mailing address:
  • Phone: 844-365-7246
  • Fax: 302-792-1372

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MS. STEFANIE PAULUS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 443-657-2468