Provider Demographics
NPI:1447580394
Name:ADVANCED PAIN SURGERY CENTER LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHALID A
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-261-7200
Mailing Address - Street 1:1050 KEY PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4551
Mailing Address - Country:US
Mailing Address - Phone:240-629-3990
Mailing Address - Fax:
Practice Address - Street 1:12070 OLD LINE CTR STE 205
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-2567
Practice Address - Country:US
Practice Address - Phone:240-629-3920
Practice Address - Fax:240-629-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-28
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical