1790881746 NPI number — ADVANCED SPINE & PAIN MANAGEMENT INC

Table of content: (NPI 1790881746)

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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