Provider Demographics
NPI:1033509971
Name:INTERVENTIONAL SPINE AND PAIN, LLP
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE AND PAIN, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:
Authorized Official - Last Name:ZEBALLOS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:214-506-2610
Mailing Address - Street 1:12221 MERIT DR STE 620
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-3222
Mailing Address - Country:US
Mailing Address - Phone:214-506-2610
Mailing Address - Fax:972-681-8727
Practice Address - Street 1:17051 NORTH DALLAS PARKWAY
Practice Address - Street 2:SUITE 300
Practice Address - City:ADDISON
Practice Address - State:TX
Practice Address - Zip Code:75001
Practice Address - Country:US
Practice Address - Phone:214-506-2610
Practice Address - Fax:214-506-1170
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-30
Last Update Date:2017-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X, 2081P2900X
TXM8781207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX193400000XOtherTAXONOMY
TX8L17155Medicare PIN
TX8J4724Medicare PIN