Healthcare Provider Details

I. General information

NPI: 1376965376
Provider Name (Legal Business Name): ADVANCED SPINE & PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 THOMAS MOORE PKWY SUITE 202
CRESTVIEW HILLS KY
41017-3410
US

IV. Provider business mailing address

320 THOMAS MOORE PKWY SUITE 202
CRESTVIEW HILLS KY
41017-3410
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-7246
  • Fax: 513-624-6900
Mailing address:
  • Phone: 859-426-7246
  • Fax: 513-624-6900

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateKY

VIII. Authorized Official

Name: DR. MUKARRAM A. KHAN
Title or Position: DO/OWNER
Credential: DO
Phone: 859-426-7246