Provider Demographics
NPI:1659722882
Name:ADVANCED SPINE AND PAIN PLLC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HOLLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SEAGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-378-4656
Mailing Address - Street 1:PO BOX 674074
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75267-4074
Mailing Address - Country:US
Mailing Address - Phone:214-378-4656
Mailing Address - Fax:866-375-8173
Practice Address - Street 1:22255 GREENFIELD RD
Practice Address - Street 2:SUITE 500
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3710
Practice Address - Country:US
Practice Address - Phone:214-378-4656
Practice Address - Fax:866-375-8173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-29
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301051183207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty