Provider Demographics
NPI:1851690515
Name:AMERICAN SPINE SURGERY CENTER LLC
Entity Type:Organization
Organization Name:AMERICAN SPINE SURGERY CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KHALID A
Authorized Official - Middle Name:
Authorized Official - Last Name:KAHLOON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-261-7200
Mailing Address - Street 1:1050 KEY PKWY STE 202
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4551
Mailing Address - Country:US
Mailing Address - Phone:240-629-3920
Mailing Address - Fax:240-629-3921
Practice Address - Street 1:1050 KEY PKWY
Practice Address - Street 2:STE 104
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4053
Practice Address - Country:US
Practice Address - Phone:240-629-3920
Practice Address - Fax:240-629-3921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2017-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QA1903X
MDMDASSC261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical