Interventional Spine Associates PA

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

INTERVENTIONAL SPINE ASSOCIATES PA

Practice address

700 Olympic Plaza Cir Ste 404
Tyler, TX 75701-1952

Phone

(903) 593-1738

Fax

(903) 596-7852

NPI assigned

Aug 5, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Robert M Sutherland, MD

Title

Owner

Phone

(903) 593-1738

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1576022400000",
    "number": "1790794121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 7939",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757117939",
            "telephone_number": "903-593-1738",
            "fax_number": "903-596-7852"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 OLYMPIC PLAZA CIR STE 404",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011952",
            "telephone_number": "903-593-1738",
            "fax_number": "903-596-7852"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "517 N Carrier Pkwy",
            "address_purpose": "LOCATION",
            "city": "Grand Prairie",
            "state": "TX",
            "postal_code": "750505484",
            "country_code": "US",
            "telephone_number": "903-593-1738",
            "fax_number": "903-596-7852",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "INTERVENTIONAL SPINE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2019-12-11",
        "certification_date": "2019-12-11",
        "status": "A",
        "authorized_official_last_name": "SUTHERLAND",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "903-593-1738",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Tyler, TX
• Providers in Tyler, TX by specialty
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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 11, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.