Healthcare Provider Details

I. General information

NPI: 1932522109
Provider Name (Legal Business Name): ADVANCED SPINE & PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2014
Last Update Date: 05/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2816 W 1ST ST
SPRINGFIELD OH
45504-4264
US

IV. Provider business mailing address

2816 W 1ST ST
SPRINGFIELD OH
45504-4264
US

V. Phone/Fax

Practice location:
  • Phone: 937-322-8977
  • Fax: 937-322-5837
Mailing address:
  • Phone: 937-322-8977
  • Fax: 937-322-5837

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: DO/OWNER
Credential: D.O.
Phone: 937-322-8977