# INTERVENTIONAL PAIN & SPINE CENTER PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114768843
- **Authorized official:** MOHAMMAD KHIZAR ALI MD (AUTHORIZED OFFICIAL)
- **Authorized official phone:** (724) 965-8946

## Contact information

- **Practice address:** 100 BRADFORD ROAD, STE 410, WEXFORD, PA 15090-8489
- **Practice address phone:** (724) 965-8946
- **Practice address fax:** (724) 965-8953
- **Mailing address:** 100 BRADFORD ROAD, STE 410, WEXFORD, PA 15090-8489
- **Mailing address phone:** (724) 965-8946
- **Mailing address fax:** (724) 965-8953

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084N0600X | Clinical Neurophysiology Physician | — | NULL | — |
| 2084N0600X | Clinical Neurophysiology Physician | — | — | — |
| 2084P2900X | Pain Medicine (Psychiatry & Neurology) Physician | — | NULL | Yes |
| 208VP0014X | Interventional Pain Medicine Physician | — | NULL | — |
| 208VP0014X | Interventional Pain Medicine Physician | — | — | — |

## Other

- **Enumeration date:** 06/05/2024
- **Last updated:** 09/11/2024