CENTER FOR ADVANCED SPINE TECHNOLOGIES INC

Provider Demographics

• NPI: 1982859518
• Name: CENTER FOR ADVANCED SPINE TECHNOLOGIES INC
• Entity Type: Organization
• Organization Name: CENTER FOR ADVANCED SPINE TECHNOLOGIES INC
• Authorized Official - Title/Position: OWNER
• Authorized Official - First Name: ABUBAKAR
• Authorized Official - Middle Name: ATIQ
• Authorized Official - Last Name: DURRANI
• Authorized Official - Credentials: MD
• Authorized Official - Phone: 877-327-2278
• Mailing Address - Street 1: 10475 READING RD
• Mailing Address - Street 2: SUITE 209
• Mailing Address - City: CINCINNATI
• Mailing Address - State: OH
• Mailing Address - Zip Code: 45241-2563
• Mailing Address - Country: US
• Mailing Address - Phone: 513-281-2278
• Mailing Address - Fax: 513-221-8219
• Practice Address - Street 1: 10475 READING RD
• Practice Address - Street 2: SUITE 209
• Practice Address - City: CINCINNATI
• Practice Address - State: OH
• Practice Address - Zip Code: 45241-2563
• Practice Address - Country: US
• Practice Address - Phone: 513-281-2278
• Practice Address - Fax: 513-221-8219
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2008-11-24
• Last Update Date: 2013-04-18

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207XS0117X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Orthopaedic Surgery of the Spine	Group - Multi-Specialty
No	111N00000X	Chiropractic Providers	Chiropractor		Group - Multi-Specialty
No	207XP3100X	Allopathic & Osteopathic Physicians	Orthopaedic Surgery	Pediatric Orthopaedic Surgery	Group - Multi-Specialty
No	208100000X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation		Group - Multi-Specialty
No	208G00000X	Allopathic & Osteopathic Physicians	Thoracic Surgery (Cardiothoracic Vascular Surgery)		Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies		Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
IN	200930810	Medicaid
KY	7100152270	Medicaid
KY	7100064720	Medicaid
OH	2926098	Medicaid
KY	7100152240	Medicaid
OH	2926098	Medicaid
KY	7100152270	Medicaid
IN	200930810	Medicaid