Provider Demographics
NPI:1730127358
Name:ADVANCED SPINE AND PAIN, LLC
Entity Type:Organization
Organization Name:ADVANCED SPINE AND PAIN, LLC
Other - Org Name:RELIEVUS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:DAMEAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-985-2727
Mailing Address - Street 1:201 DEFENSE HWY STE 205
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7096
Mailing Address - Country:US
Mailing Address - Phone:888-985-2727
Mailing Address - Fax:856-779-0211
Practice Address - Street 1:700 E TOWNSHIP LINE RD
Practice Address - Street 2:FIRST FLOOR
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-5733
Practice Address - Country:US
Practice Address - Phone:888-985-2727
Practice Address - Fax:856-779-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-04
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1010935440001Medicaid
PA1247138OtherAMERICHOICE PPO
PADA6164OtherRAILROAD MEDICARE GROUP
PA1426867OtherPERSONAL CHOICE
NJ0091324Medicaid
NJ11-3650843OtherHORIZON BLUE CROSS BLUE SHIELD OF NJ
PA1426867OtherHIGHMARK BLUE SHIELD
PA2115319000OtherKEYSTONE HEALTH PLAN EAST
PA1010935440001Medicaid
NJ0091324Medicaid