1164868162 NPI number — SPINE & PAIN ASSOCIATES PLLC

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 1164868162 NPI number — SPINE & PAIN ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPINE & PAIN ASSOCIATES PLLC
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:
1164868162
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/16/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1716 E HUNDRED RD
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23836-3301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-681-0177
Provider Business Mailing Address Fax Number:
804-681-0747

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1716 E HUNDRED RD
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23836-3301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-681-0177
Provider Business Practice Location Address Fax Number:
804-681-0747
Provider Enumeration Date:
05/16/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
AHMAD
Authorized Official First Name:
USMAN
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
718-705-4695

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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