Healthcare Provider Details

I. General information

NPI: 1760835839
Provider Name (Legal Business Name): CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2016
Last Update Date: 07/03/2023
Certification Date: 07/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ARRANDALE BLVD STE 103
EXTON PA
19341-2503
US

IV. Provider business mailing address

291 CARTER DR STE A
MIDDLETOWN DE
19709-5845
US

V. Phone/Fax

Practice location:
  • Phone: 844-365-7246
  • Fax: 844-516-0080
Mailing address:
  • Phone: 844-365-7246
  • Fax: 844-516-0080

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MS. STEFANIE PAULUS
Title or Position: BUSINESS MANAGER
Credential:
Phone: 844-365-7246