# CENTER FOR INTERVENTIONAL SPINE, A MEDICAL CORPORATION

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

## Provider details

- **NPI number:** 1982088365
- **Authorized official:** LESLEY GEARITY (CREDENTIALING SPECIALIST)
- **Authorized official phone:** (727) 877-5419

## Contact information

- **Practice address:** 1817 PROFESSIONAL DRIVE, SACRAMENTO, CA 95825
- **Practice address phone:** (727) 877-5419
- **Practice address fax:** (727) 877-5419
- **Mailing address:** 311 PARK PLACE BLVD, 5TH FLOOR, CLEARWATER, FL 33759
- **Mailing address phone:** (727) 877-5419
- **Mailing address fax:** (727) 877-5419

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | A60900 | CA | Yes |

## Other

- **Enumeration date:** 07/15/2015
- **Last updated:** 07/15/2015