Healthcare Provider Details

I. General information

NPI: 1407278930
Provider Name (Legal Business Name): ADVANCED SPINE & PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 HOSPITAL DR SUITE 100
BATAVIA OH
45103-1921
US

IV. Provider business mailing address

3020 HOSPITAL DR SUITE 100
BATAVIA OH
45103-1921
US

V. Phone/Fax

Practice location:
  • Phone: 513-732-8710
  • Fax: 513-624-6922
Mailing address:
  • Phone: 513-732-8710
  • 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 StateOH
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateOH

VIII. Authorized Official

Name: DR. MUKARRAM A. KHAN
Title or Position: OWNER/PRESIDENT
Credential: DO
Phone: 513-732-8710