Healthcare Provider Details

I. General information

NPI: 1588403448
Provider Name (Legal Business Name): INTEGRATED PAIN SOLUTIONS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2024
Last Update Date: 05/21/2024
Certification Date: 05/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MEDICAL CAMPUS DR NW STE 207
SUPPLY NC
28462-4094
US

IV. Provider business mailing address

695 S BENNETT ST
SOUTHERN PINES NC
28387-5919
US

V. Phone/Fax

Practice location:
  • Phone: 910-687-4888
  • Fax:
Mailing address:
  • Phone: 910-725-1708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES E TAYLOR
Title or Position: PRESIDENT
Credential: MD
Phone: 910-725-1708