MEDICARE: THE INTERVENTIONAL PAIN & SPINE INSTITUTE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	8932	FL

General Provider Information

NPI Number	:	1740447705
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	THE INTERVENTIONAL PAIN & SPINE INSTITUTE

Provider Business Mailing Address
First Line	:	2480 E COMMERCIAL BLVD
Second Line	:	SUITE 1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4025
Country	:	US
Telephone Number	:	954-533-8400
Fax Number	:	954-533-8500

Provider Business Practice Location Address
First Line	:	2480 E COMMERCIAL BLVD
Second Line	:	SUITE 1
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-4025
Country	:	US
Telephone Number	:	954-533-8400
Fax Number	:	954-533-8500

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DANNNELL BOSSERMAN ANSCHUETZ
Credential	:	DO
Telephone Number	:	954-533-8400

Provider Enumeration Date	:	05/19/2008
Last Update Date	:	05/19/2008

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Directions to “THE INTERVENTIONAL PAIN & SPINE INSTITUTE ” Practice Location

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