Provider Demographics
NPI:1144609157
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:D.O., AUTHORZED OFFICIAL
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:214-888-3900
Mailing Address - Street 1:12221 MERIT DR
Mailing Address - Street 2:SUITE 620
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75251-2202
Mailing Address - Country:US
Mailing Address - Phone:214-506-2610
Mailing Address - Fax:972-681-8727
Practice Address - Street 1:7115 GREENVILLE AVE STE 230
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75231
Practice Address - Country:US
Practice Address - Phone:214-888-3888
Practice Address - Fax:214-888-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-22
Last Update Date:2018-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7083350002OtherDME
TX193200000XOther193200000X