Provider Demographics
NPI:1205159050
Name:ADVANCED SPINE AND PAIN CENTER
Entity type:Organization
Organization Name:ADVANCED SPINE AND PAIN CENTER
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EDMUND
Authorized Official - Middle Name:
Authorized Official - Last Name:PASIMIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-386-0909
Mailing Address - Street 1:2980 N BEVERLY GLEN CIR
Mailing Address - Street 2:STE 301
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90077-1726
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:801 S RANCHO DR
Practice Address - Street 2:STE A-3
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-3854
Practice Address - Country:US
Practice Address - Phone:702-386-0909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ADVANCED SPINE AND PAIN CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-03-09
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG54146Medicare UPIN