Provider Demographics
NPI:1679762876
Name:PREMIER SPINE & PAIN CENTER PA
Entity Type:Organization
Organization Name:PREMIER SPINE & PAIN CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANDRAWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-264-0770
Mailing Address - Street 1:1543 KINGSLEY AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32073-4583
Mailing Address - Country:US
Mailing Address - Phone:904-264-0770
Mailing Address - Fax:904-264-0670
Practice Address - Street 1:1543 KINGSLEY AVE STE 3
Practice Address - Street 2:
Practice Address - City:ORANGE PARK
Practice Address - State:FL
Practice Address - Zip Code:32073-4583
Practice Address - Country:US
Practice Address - Phone:904-264-0770
Practice Address - Fax:904-264-0670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-24
Last Update Date:2013-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty