MEDICARE: INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician
3	208VP0014X	Interventional Pain Medicine Physician
4	332B00000X	Durable Medical Equipment & Medical Supplies
5	363A00000X	Physician Assistant
6	367H00000X	Anesthesiologist Assistant
7	363AM0700X	Medical Physician Assistant
8	363L00000X	Nurse Practitioner
9	367500000X	Certified Registered Nurse Anesthetist
10	208VP0000X	Pain Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	18D2154151	OTHER	KY	CLIA

General Provider Information

NPI Number	:	1184110231
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	7145 E VIRGINIA ST
Second Line	:
City	:	EVANSVILLE
State	:	IN
Zip	:	47715-9144
Country	:	US
Telephone Number	:	812-962-7890
Fax Number	:	812-476-6162

Provider Business Practice Location Address
First Line	:	2700 OLD ROSEBUD RD STE 350
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40509-8630
Country	:	US
Telephone Number	:	502-352-2530
Fax Number	:	859-477-8287

Authorized Official
Title or Position	:	AUTHORIZED OFFICIAL
Name	:	TAMIA FISHER
Credential	:
Telephone Number	:	812-962-7894

Provider Enumeration Date	:	07/02/2018
Last Update Date	:	10/03/2023

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Directions to “INTERVENTIONAL PAIN & SPINE SPECIALISTS LLC ” Practice Location

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