Provider Demographics
NPI:1710468129
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:PRACTICE MANAGER
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 1:291 CARTER DR STE A
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:DE
Mailing Address - Zip Code:19709-5845
Mailing Address - Country:US
Mailing Address - Phone:844-365-7246
Mailing Address - Fax:844-516-0080
Practice Address - Street 1:1197 AIRPORT RD STE 5
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:DE
Practice Address - Zip Code:19963-6418
Practice Address - Country:US
Practice Address - Phone:844-365-7246
Practice Address - Fax:844-516-0080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-08-23
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies