Provider Demographics
NPI:1083069587
Name:ADVANCED SPINE AND PAIN CENTERS INC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-219-1114
Mailing Address - Street 1:410 DENISON ST
Mailing Address - Street 2:
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-6128
Mailing Address - Country:US
Mailing Address - Phone:501-764-1437
Mailing Address - Fax:
Practice Address - Street 1:410 DENISON ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72034-6128
Practice Address - Country:US
Practice Address - Phone:501-219-1114
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain