1790881746 NPI number — ADVANCED SPINE & PAIN MANAGEMENT INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790881746 NPI number — ADVANCED SPINE & PAIN MANAGEMENT INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED SPINE & PAIN MANAGEMENT INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1790881746
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7691 5 MILE RD
Provider Second Line Business Mailing Address:
SUITE 10
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45230-2163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-624-7246
Provider Business Mailing Address Fax Number:
513-624-6900

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7691 5 MILE RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45230-4348
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-624-7246
Provider Business Practice Location Address Fax Number:
513-624-6900
Provider Enumeration Date:
09/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KHAN
Authorized Official First Name:
MUKARRAM
Authorized Official Middle Name:
ALI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-624-7246

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  34.008823 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X , with the licence number: 34.008823 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2679703 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 296827989001 . This is a "MEDICAL MUTUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100315340 - MD GRP , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 617433400 . This is a "DEPT OF LABOR - MD" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 617465100 . This is a "DEPT. OF LABOR - APRN" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 150730 . This is a "NATIONWIDE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 6226080 . This is a "CIGNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7100287020 -NP GROUP , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 317306 . This is a "AMERIGROUP" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7100240230 MD GRP # , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000488997 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 617433404 . This is a "US DEPT OF LABOR - EATON OFFICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 617433403 . This is a "US DEPT OF LABOR - SPRINGFIELD OFFICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 617433406 . This is a "US DEPT OF LABOR - SPRINGBORO OFFICE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00415701 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




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