# CENTER FOR SPINE AND SPORTS MEDICINE LLC

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

## Provider details

- **NPI number:** 1801918024
- **Authorized official:** LISA KAY HASTETTER (PRACTICE MANAGER)
- **Authorized official phone:** (812) 476-7111

## Contact information

- **Practice address:** 7145 E VIRGINIA ST, EVANSVILLE, IN 47715-9144
- **Practice address phone:** (812) 476-7111
- **Practice address fax:** (812) 476-7117
- **Mailing address:** 7145 E VIRGINIA ST, SUITE 5000, EVANSVILLE, IN 47715-9144
- **Mailing address phone:** (812) 476-7111
- **Mailing address fax:** (812) 476-7117

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 01068416A | IN | Yes |
| 2081P2900X | Pain Medicine (Physical Medicine & Rehabilitation) Physician | 01040195A | IN | — |

## Other

- **Enumeration date:** 04/06/2007
- **Last updated:** 01/13/2015