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General NPI Number Information
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NPI Number | 1790384071
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC
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Dates
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Enumeration Date | 10/19/2020
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 4205 SPRINGHURST BLVD STE 101
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City | LOUISVILLE
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State | KY
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Zip | 40241-6159
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Country | US
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Telephone | 502-352-2530
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Fax |
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Provider Business Mailing Address
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Address Line | 7145 E VIRGINIA ST STE 2000
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City | EVANSVILLE
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State | IN
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Zip | 47715-9147
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Country | US
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Telephone | 812-962-7894
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TAMIA FISHER
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Credential |
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Telephone | 812-962-7894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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