MEDICARE: ACTIVE SPINE & REHAB, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1427609429
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACTIVE SPINE & REHAB, LLC

Provider Business Mailing Address
First Line	:	10753 BIRMINGHAM WAY
Second Line	:
City	:	WOODSTOCK
State	:	MD
Zip	:	21163-1535
Country	:	US
Telephone Number	:	410-970-8190
Fax Number	:

Provider Business Practice Location Address
First Line	:	802 CROMWELL PARK DR
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-2563
Country	:	US
Telephone Number	:	410-970-8190
Fax Number	:	410-313-8314

Authorized Official
Title or Position	:	DIRECTOR OF REVENUE CYCLE
Name	:	PATRICK MURRAY
Credential	:
Telephone Number	:	410-970-8190

Provider Enumeration Date	:	09/23/2019
Last Update Date	:	09/23/2019

Similar Medicare Providers

1619830254 — PARENTS' PLACE OF MARYLAND, INC.
Practice Location Address:

802 CROMWELL PARK DR STE H
GLEN BURNIE, MD
21061-2563

Practice Phone: 410-768-9100
Practice Fax: 410-768-0830

1326735358 — LAUREN COSTIGAN RDN
Practice Location Address:

48553 SHADY GLEN CT
CHESTERFIELD, MI
48051-2563

Practice Phone: 586-339-7527
Practice Fax:

1407719313 — JULIA GILL DNP-FNP
Practice Location Address:

1412 CRAIN HWY N STE 6A
GLEN BURNIE, MD
21061-7000

Practice Phone: 410-761-3900
Practice Fax:

1023266145 — ASC DEVELOPMENT COMPANY, LLC
Practice Location Address:

1600 CRAIN HWY S , SUITE 301
GLEN BURNIE, MD
21061-5577

Practice Phone: 410-787-8315
Practice Fax: 410-787-8316

1538487582 — CENTER FOR PAIN MANAGEMENT, LLC
Practice Location Address:

1600 CRAIN HWY S , SUITE 301
GLEN BURNIE, MD
21061-5577

Practice Phone: 410-787-8315
Practice Fax: 410-787-8316

1245707843 — CENTER FOR PAIN MANAGEMENT LLC
Practice Location Address:

1600 CRAIN HWY S STE 301
GLEN BURNIE, MD
21061-6446

Practice Phone: 410-787-8315
Practice Fax: 410-787-8316

Directions to “ACTIVE SPINE & REHAB, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.