Provider Demographics
NPI:1851765804
Name:ADVANCED PAIN & BACK INSTITUTE, INC.
Entity Type:Organization
Organization Name:ADVANCED PAIN & BACK INSTITUTE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG
Authorized Official - Middle Name:XUAN
Authorized Official - Last Name:VO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:832-348-9475
Mailing Address - Street 1:5425 W BELMONT AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60641-4127
Mailing Address - Country:US
Mailing Address - Phone:312-702-1313
Mailing Address - Fax:844-269-6602
Practice Address - Street 1:5425 W BELMONT AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60641-4127
Practice Address - Country:US
Practice Address - Phone:312-702-1313
Practice Address - Fax:844-269-6602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036130509208VP0014X
283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No283X00000XHospitalsRehabilitation HospitalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036130509Medicaid
ILF400100458Medicare PIN