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General NPI Number Information
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NPI Number | 1851690515
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Entity Type | Organization
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Legal Business Name | AMERICAN SPINE SURGERY CENTER LLC
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Dates
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Enumeration Date | 03/21/2011
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Last Update Date | 12/10/2017
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Provider Practice Location Address
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Address Line | 1050 KEY PKWY STE 104
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City | FREDERICK
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State | MD
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Zip | 21702-4053
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Country | US
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Telephone | 240-629-3920
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Fax | 240-629-3921
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Provider Business Mailing Address
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Address Line | 1050 KEY PKWY STE 202
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City | FREDERICK
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State | MD
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Zip | 21702-4551
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Country | US
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Telephone | 240-629-3920
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Fax | 240-629-3921
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Authorized Official
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Title or Position | CEO
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Name | KHALID A KAHLOON
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Credential |
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Telephone | 502-261-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | MDASSC
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License Number State | MD
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