Healthcare Provider Details

I. General information

NPI: 1982207478
Provider Name (Legal Business Name): INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2020
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 E VIRGINIA ST STE 1000
EVANSVILLE IN
47715-9147
US

IV. Provider business mailing address

7145 E VIRGINIA ST STE 2000
EVANSVILLE IN
47715-9147
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-6166
  • Fax:
Mailing address:
  • Phone: 812-962-7894
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAMIA FISHER
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 812-962-7894