Provider Demographics
NPI:1114768843
Name:INTERVENTIONAL PAIN & SPINE CENTER PLLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN & SPINE CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:MOHAMMAD
Authorized Official - Middle Name:KHIZAR
Authorized Official - Last Name:ALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-965-8946
Mailing Address - Street 1:100 BRADFORD ROAD
Mailing Address - Street 2:STE 410
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-8489
Mailing Address - Country:US
Mailing Address - Phone:724-965-8946
Mailing Address - Fax:724-965-8953
Practice Address - Street 1:100 BRADFORD ROAD
Practice Address - Street 2:STE 410
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-8489
Practice Address - Country:US
Practice Address - Phone:724-965-8946
Practice Address - Fax:724-965-8953
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain MedicineGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty