Provider Demographics
NPI:1508212820
Name:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Entity Type:Organization
Organization Name:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-365-7246
Mailing Address - Street 1:223 WILMINGTON W CHESTER PIKE STE 214
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9007
Mailing Address - Country:US
Mailing Address - Phone:844-365-7246
Mailing Address - Fax:610-361-7956
Practice Address - Street 1:3401 BRANDYWINE PKWY STE 202
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803-1554
Practice Address - Country:US
Practice Address - Phone:443-657-2468
Practice Address - Fax:302-792-1372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-05
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies