Provider Demographics
NPI:1891021903
Name:DEFINITIVE INTERVENTIONAL SPINE CENTER
Entity Type:Organization
Organization Name:DEFINITIVE INTERVENTIONAL SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:JASON
Authorized Official - Last Name:FILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-543-0012
Mailing Address - Street 1:10507 E WILDWIND CIR
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380-4043
Mailing Address - Country:US
Mailing Address - Phone:713-562-7890
Mailing Address - Fax:281-605-4566
Practice Address - Street 1:6225 FM 2920 RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SPRING
Practice Address - State:TX
Practice Address - Zip Code:77379-3474
Practice Address - Country:US
Practice Address - Phone:713-562-7890
Practice Address - Fax:281-605-4566
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-23
Last Update Date:2009-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK8150208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty