Provider Demographics
NPI:1972843399
Name:CENTER FOR INTERVENTIONAL SPINE, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:CENTER FOR INTERVENTIONAL SPINE, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:REED
Authorized Official - Last Name:CATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-473-7602
Mailing Address - Street 1:1817 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2106
Mailing Address - Country:US
Mailing Address - Phone:916-977-0741
Mailing Address - Fax:916-977-0547
Practice Address - Street 1:1970 LAKE BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-5663
Practice Address - Country:US
Practice Address - Phone:916-977-0741
Practice Address - Fax:916-977-0547
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-21
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA609002081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty