Provider Demographics
NPI:1003120080
Name:SPINE INTERVENTION, LLC
Entity Type:Organization
Organization Name:SPINE INTERVENTION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:
Authorized Official - Last Name:DEFRANCESCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-479-8000
Mailing Address - Street 1:2840 W AIRLINE HWY
Mailing Address - Street 2:SUITE A
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70068-2951
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1919 VETERANS MEMORIAL BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70062-4003
Practice Address - Country:US
Practice Address - Phone:504-469-9641
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-02
Last Update Date:2010-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0225962081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty