Healthcare Provider Details

I. General information

NPI: 1740447705
Provider Name (Legal Business Name): THE INTERVENTIONAL PAIN & SPINE INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2008
Last Update Date: 05/19/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2480 E COMMERCIAL BLVD SUITE 1
FORT LAUDERDALE FL
33308-4025
US

IV. Provider business mailing address

2480 E COMMERCIAL BLVD SUITE 1
FORT LAUDERDALE FL
33308-4025
US

V. Phone/Fax

Practice location:
  • Phone: 954-533-8400
  • Fax: 954-533-8500
Mailing address:
  • Phone: 954-533-8400
  • Fax: 954-533-8500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number8932
License Number StateFL

VIII. Authorized Official

Name: DANNNELL BOSSERMAN ANSCHUETZ
Title or Position: PRESIDENT
Credential: DO
Phone: 954-533-8400