Provider Demographics
NPI:1851557854
Name:THE INTERVENTIONAL PAIN AND SPINE INSTITUTE
Entity Type:Organization
Organization Name:THE INTERVENTIONAL PAIN AND SPINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANNELL
Authorized Official - Middle Name:BOSSERMAN
Authorized Official - Last Name:ANSCHUETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:954-533-8400
Mailing Address - Street 1:5333 N DIXIE HWY
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OAKLAND PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33334-3414
Mailing Address - Country:US
Mailing Address - Phone:954-533-8400
Mailing Address - Fax:954-533-8500
Practice Address - Street 1:5333 N DIXIE HWY
Practice Address - Street 2:SUITE 202
Practice Address - City:OAKLAND PARK
Practice Address - State:FL
Practice Address - Zip Code:33334-3414
Practice Address - Country:US
Practice Address - Phone:954-533-8400
Practice Address - Fax:954-533-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-30
Last Update Date:2016-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS8932208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AQ272AMedicare UPIN