Provider Demographics
NPI:1508355181
Name:INTEGRATED PAIN SERVICES INC
Entity Type:Organization
Organization Name:INTEGRATED PAIN SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDEZ-VIGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-982-7447
Mailing Address - Street 1:PO BOX 550897
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32255-0897
Mailing Address - Country:US
Mailing Address - Phone:904-717-9625
Mailing Address - Fax:904-683-6499
Practice Address - Street 1:3101 UNIVERSITY BLVD S STE 200
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2753
Practice Address - Country:US
Practice Address - Phone:904-717-9625
Practice Address - Fax:904-683-6499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-09
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty