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Organization
CENTER FOR SPINE AND SPORTS MEDICINE LLC
Active
Organization
CENTER FOR SPINE AND SPORTS MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LISA KAY HASTETTER (PRACTICE MANAGER)
(812) 476-7111
Entity
Organization
Contact information
Practice address
7145 E VIRGINIA ST, EVANSVILLE, IN 47715-9144
(812) 476-7111
(812) 476-7117
Mailing address
7145 E VIRGINIA ST, SUITE 5000, EVANSVILLE, IN 47715-9144
(812) 476-7111
(812) 476-7117
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
01068416A
IN
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
01040195A
IN
Other
Enumeration date
04/06/2007
Last updated
01/13/2015
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