Healthcare Provider Details

I. General information

NPI: 1144609157
Provider Name (Legal Business Name): INTERVENTIONAL SPINE AND PAIN, LLP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2015
Last Update Date: 08/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7115 GREENVILLE AVE STE 230
DALLAS TX
75231
US

IV. Provider business mailing address

12221 MERIT DR SUITE 620
DALLAS TX
75251-2202
US

V. Phone/Fax

Practice location:
  • Phone: 214-888-3888
  • Fax: 214-888-3901
Mailing address:
  • Phone: 214-506-2610
  • Fax: 972-681-8727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: PABLO ZEBALLOS
Title or Position: D.O., AUTHORZED OFFICIAL
Credential: D.O.
Phone: 214-888-3900