Provider Demographics
NPI:1669008330
Name:PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Entity Type:Organization
Organization Name:PAIN AND SPINE SPECIALISTS OF MARYLAND, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:STACI
Authorized Official - Middle Name:
Authorized Official - Last Name:POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-703-8767
Mailing Address - Street 1:2702 BACK ACRE CIR STE 290B
Mailing Address - Street 2:
Mailing Address - City:MOUNT AIRY
Mailing Address - State:MD
Mailing Address - Zip Code:21771-7769
Mailing Address - Country:US
Mailing Address - Phone:301-703-8767
Mailing Address - Fax:301-703-8886
Practice Address - Street 1:6816 DEERPATH RD STE 201
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-6200
Practice Address - Country:US
Practice Address - Phone:301-703-8767
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-13
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility