Provider Demographics
NPI:1811342496
Name:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Entity type:Organization
Organization Name:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PAULUS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-657-2468
Mailing Address - Street 1:223 WILMINGTON W CHESTER PIKE STE 214
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-9007
Mailing Address - Country:US
Mailing Address - Phone:844-365-7246
Mailing Address - Fax:610-361-7956
Practice Address - Street 1:2701 BLAIR MILL RD STE 35
Practice Address - Street 2:
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-1041
Practice Address - Country:US
Practice Address - Phone:443-657-2468
Practice Address - Fax:215-706-4191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTER FOR INTERVENTIONAL PAIN SPINE LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-05-02
Last Update Date:2020-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332B00000X
PAMD421194332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332900000XSuppliersNon-Pharmacy Dispensing Site