Provider Demographics
NPI:1578890927
Name:CENTER FOR ADVANCED SPINE TECHNOLOGIES, INC.
Entity Type:Organization
Organization Name:CENTER FOR ADVANCED SPINE TECHNOLOGIES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ABUBAKAR
Authorized Official - Middle Name:ATIQ
Authorized Official - Last Name:DURRANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-281-2278
Mailing Address - Street 1:4555 LAKE FOREST DR
Mailing Address - Street 2:SUITE 150
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-3785
Mailing Address - Country:US
Mailing Address - Phone:513-281-2278
Mailing Address - Fax:888-322-2278
Practice Address - Street 1:4555 LAKE FOREST DR
Practice Address - Street 2:SUITE 150
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-3785
Practice Address - Country:US
Practice Address - Phone:513-281-2278
Practice Address - Fax:888-322-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-05
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085087207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2555588Medicaid
KY64107618Medicaid
IN200503730Medicaid
IN200503730Medicaid