Provider Demographics
NPI:1801136155
Name:ADVANCED SPINE SOLUTIONS PA
Entity type:Organization
Organization Name:ADVANCED SPINE SOLUTIONS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:B
Authorized Official - Last Name:JAMES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:855-265-9500
Mailing Address - Street 1:651 S MAIN ST
Mailing Address - Street 2:105
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-7038
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:651 S MAIN ST
Practice Address - Street 2:105
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-7038
Practice Address - Country:US
Practice Address - Phone:855-265-9500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-24
Last Update Date:2013-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center