Provider Demographics
NPI:1710393558
Name:INTERVENTIONAL SPINE SPECIALISTS, LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE SPECIALISTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:C
Authorized Official - Last Name:PADULA
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-366-5752
Mailing Address - Street 1:150 SW 12TH AVE
Mailing Address - Street 2:101
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33069-3298
Mailing Address - Country:US
Mailing Address - Phone:954-366-5752
Mailing Address - Fax:
Practice Address - Street 1:150 SW 12TH AVE
Practice Address - Street 2:101
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33069-3298
Practice Address - Country:US
Practice Address - Phone:954-366-5752
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty