Healthcare Provider Details

I. General information

NPI: 1578567459
Provider Name (Legal Business Name): INTEGRATIVE PAIN SERVICES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 08/22/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4807 SPICEWOOD SPRINGS RD STE 1235
AUSTIN TX
78759-8478
US

IV. Provider business mailing address

4807 SPICEWOOD SPRINGS RD STE 1235
AUSTIN TX
78759-8478
US

V. Phone/Fax

Practice location:
  • Phone: 512-795-9977
  • Fax: 512-418-8445
Mailing address:
  • Phone: 512-795-9977
  • Fax: 512-418-8445

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: MARK STEPHEN WHITE
Title or Position: PRESIDENT
Credential: D.O.
Phone: 512-795-9977