Provider Demographics
NPI:1245630557
Name:INTEGRATIVE SPORTS AND SPINE INC
Entity type:Organization
Organization Name:INTEGRATIVE SPORTS AND SPINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-473-7377
Mailing Address - Street 1:9080 IRVINE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-4658
Mailing Address - Country:US
Mailing Address - Phone:949-540-5641
Mailing Address - Fax:949-540-5642
Practice Address - Street 1:9080 IRVINE CENTER DR
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-4658
Practice Address - Country:US
Practice Address - Phone:949-540-5641
Practice Address - Fax:949-540-5642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-25
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB224810Medicare PIN