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General NPI Number Information
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NPI Number | 1427571355
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL SPINE & PAIN, LLP
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Dates
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Enumeration Date | 07/23/2017
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Last Update Date | 12/07/2018
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Provider Practice Location Address
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Address Line | 8222 DOUGLAS AVENUE STE. 890
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City | DALLAS
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State | TX
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Zip | 75225-7036
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Country | US
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Telephone | 214-888-3900
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Fax | 972-681-8727
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Provider Business Mailing Address
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Address Line | ATTN: CYNTHIA REYNOLDS CREDENTIALER 18670 GRAPHICS DR. STE. 100
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City | TINLEY PARK
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State | IL
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Zip | 60477-6653
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Country | US
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Telephone | 708-228-4262
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Fax | 708-314-7505
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Authorized Official
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Title or Position | OWNER
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Name | PABLO ZEBALLOS
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Credential | MD
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Telephone | 219-218-2484
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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