Provider Demographics
NPI:1578567459
Name:INTEGRATIVE PAIN SERVICES PA
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN SERVICES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEPHEN
Authorized Official - Last Name:WHITE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-795-9977
Mailing Address - Street 1:4807 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:STE 1235
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8478
Mailing Address - Country:US
Mailing Address - Phone:512-795-9977
Mailing Address - Fax:512-418-8445
Practice Address - Street 1:4807 SPICEWOOD SPRINGS RD
Practice Address - Street 2:STE 1235
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8478
Practice Address - Country:US
Practice Address - Phone:512-795-9977
Practice Address - Fax:512-418-8445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-09
Last Update Date:2007-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00308TMedicare ID - Type UnspecifiedGROUP #