1720224959 NPI number — CENTER FOR ADVANCED SPINE TECHNOLOGIES, 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 1720224959 NPI number — CENTER FOR ADVANCED SPINE TECHNOLOGIES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR ADVANCED SPINE TECHNOLOGIES, 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:
1720224959
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10475 READING RD
Provider Second Line Business Mailing Address:
STE 209
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45241-2563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-281-2278
Provider Business Mailing Address Fax Number:
513-221-8219

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6905B BURLINGTON PIKE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41042-1618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-281-2278
Provider Business Practice Location Address Fax Number:
513-733-1990
Provider Enumeration Date:
12/17/2008

Additional Information

Authorized Official

Authorized Official Last Name:
DURRANI
Authorized Official First Name:
ABUBAKAR
Authorized Official Middle Name:
ATIQ
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
513-281-2278

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XP3100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200930810 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100166250 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100166230 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7100193890 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2921244 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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