Provider Demographics
NPI:1326588054
Name:INTERVENTIONAL SPECIALIST CENTER, LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL SPECIALIST CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:HEATHER
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH-FERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-513-0055
Mailing Address - Street 1:2350 VANDERBILT BEACH RD
Mailing Address - Street 2:SUITE #302B
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-2760
Mailing Address - Country:US
Mailing Address - Phone:239-513-0055
Mailing Address - Fax:239-596-6544
Practice Address - Street 1:2350 VANDERBILT BEACH RD
Practice Address - Street 2:SUITE #302B
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-2760
Practice Address - Country:US
Practice Address - Phone:239-513-0055
Practice Address - Fax:239-596-6544
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-28
Last Update Date:2017-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98168207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1952478323OtherNPI
FLAD798ZMedicare UPIN