Provider Demographics
NPI:1447906706
Name:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Entity type:Organization
Organization Name:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-365-7246
Mailing Address - Street 1:223 WILMINGTON W CHESTER PIKE STE 214
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9007
Mailing Address - Country:US
Mailing Address - Phone:844-365-7246
Mailing Address - Fax:
Practice Address - Street 1:360 E PULASKI HWY STE 3B
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6596
Practice Address - Country:US
Practice Address - Phone:844-365-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR INTERVENTIONAL PAIN SPINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-02-25
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty