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General NPI Number Information
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NPI Number | 1578567459
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Entity Type | Organization
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Legal Business Name | INTEGRATIVE PAIN SERVICES PA
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Dates
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Enumeration Date | 06/09/2005
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Last Update Date | 08/22/2007
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Provider Practice Location Address
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Address Line | 4807 SPICEWOOD SPRINGS RD STE 1235
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City | AUSTIN
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State | TX
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Zip | 78759-8478
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Country | US
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Telephone | 512-795-9977
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Fax | 512-418-8445
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Provider Business Mailing Address
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Address Line | 4807 SPICEWOOD SPRINGS RD STE 1235
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City | AUSTIN
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State | TX
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Zip | 78759-8478
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Country | US
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Telephone | 512-795-9977
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Fax | 512-418-8445
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK STEPHEN WHITE
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Credential | D.O.
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Telephone | 512-795-9977
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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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