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General NPI Number Information
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NPI Number | 1487381406
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Entity Type | Organization
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Legal Business Name | ADVANCED ORTHOSPINE INSTITUTE, LLC
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Dates
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Enumeration Date | 08/02/2022
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Last Update Date | 08/02/2022
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Provider Practice Location Address
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Address Line | 10012 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1826
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Country | US
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Telephone | 618-239-0678
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Fax | 800-516-2392
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Provider Business Mailing Address
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Address Line | 10012 MANCHESTER RD
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City | SAINT LOUIS
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State | MO
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Zip | 63122-1826
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Country | US
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Telephone | 618-239-0678
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Fax | 800-516-2392
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | SHAKEEL AHMED
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Credential | MD
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Telephone | 618-239-0678
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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