Healthcare Provider Details

I. General information

NPI: 1245306489
Provider Name (Legal Business Name): SPINAL CARE PAIN ASSOCIATES, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 S BROAD ST 3RD FLOOR
PHILADELPHIA PA
19145-4418
US

IV. Provider business mailing address

2410 S BROAD ST 3RD FLOOR
PHILADELPHIA PA
19145-4418
US

V. Phone/Fax

Practice location:
  • Phone: 215-462-6600
  • Fax: 215-462-2650
Mailing address:
  • Phone: 215-462-6600
  • Fax: 215-462-2650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GLENN MILLER
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 215-462-6600