Provider Demographics
NPI:1467643304
Name:INTERVENTIONAL SPINE AND PAIN, P.C.
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE AND PAIN, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASVEER
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:GREWAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:574-304-1519
Mailing Address - Street 1:700 E BEARDSLEY AVE STE 4B
Mailing Address - Street 2:
Mailing Address - City:ELKHART
Mailing Address - State:IN
Mailing Address - Zip Code:46514-3303
Mailing Address - Country:US
Mailing Address - Phone:574-304-1519
Mailing Address - Fax:574-350-2441
Practice Address - Street 1:700 E BEARDSLEY AVE STE 4B
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3303
Practice Address - Country:US
Practice Address - Phone:574-304-1519
Practice Address - Fax:574-350-2441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-06
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200866150AMedicaid
IN200866150AMedicaid
IN6214820001Medicare NSC