Provider Demographics
NPI:1487932406
Name:INTERVENTIONAL PAIN OF CENLA, LLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN OF CENLA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SEAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:STEHR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-441-1111
Mailing Address - Street 1:3311 PRESCOTT RD
Mailing Address - Street 2:SUITE 311
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3900
Mailing Address - Country:US
Mailing Address - Phone:318-441-1111
Mailing Address - Fax:318-441-2252
Practice Address - Street 1:3311 PRESCOTT RD
Practice Address - Street 2:SUITE 311
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3900
Practice Address - Country:US
Practice Address - Phone:318-441-1111
Practice Address - Fax:318-441-2252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-25
Last Update Date:2012-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.204312261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty