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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