Provider Demographics
NPI:1497993844
Name:INTERVENTIONAL PAIN SPECIALISTS, LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALBERT
Authorized Official - Middle Name:J
Authorized Official - Last Name:GROS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-407-4512
Mailing Address - Street 1:PO BOX 69
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70571-0069
Mailing Address - Country:US
Mailing Address - Phone:337-407-4512
Mailing Address - Fax:337-407-4514
Practice Address - Street 1:3983 I 49 S SERVICE RD
Practice Address - Street 2:
Practice Address - City:OPELOUSAS
Practice Address - State:LA
Practice Address - Zip Code:70570-0758
Practice Address - Country:US
Practice Address - Phone:337-407-4512
Practice Address - Fax:337-407-4514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-22
Last Update Date:2023-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1574881Medicaid
LA1574881Medicaid