Provider Demographics
NPI:1457740672
Name:INTERVENTIONAL SPINE ASSOCIATES, PA
Entity Type:Organization
Organization Name:INTERVENTIONAL SPINE ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:M
Authorized Official - Last Name:SUTHERLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-593-1738
Mailing Address - Street 1:PO BOX 7939
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75711-7939
Mailing Address - Country:US
Mailing Address - Phone:903-593-1738
Mailing Address - Fax:903-596-7852
Practice Address - Street 1:5550 LBJ FWY
Practice Address - Street 2:SUITE 360
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75240-6217
Practice Address - Country:US
Practice Address - Phone:903-593-1738
Practice Address - Fax:903-596-7852
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty