Provider Demographics
NPI:1245306489
Name:SPINAL CARE PAIN ASSOCIATES, P.C.
Entity type:Organization
Organization Name:SPINAL CARE PAIN ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:215-462-6600
Mailing Address - Street 1:2410 S BROAD ST
Mailing Address - Street 2:3RD FLOOR
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19145-4418
Mailing Address - Country:US
Mailing Address - Phone:215-462-6600
Mailing Address - Fax:215-462-2650
Practice Address - Street 1:2410 S BROAD ST
Practice Address - Street 2:3RD FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-4418
Practice Address - Country:US
Practice Address - Phone:215-462-6600
Practice Address - Fax:215-462-2650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2992866OtherAETNA
PA2100648000OtherKEYSTONE EAST
PA30001785OtherKEYSTONE MERCY
PA347886100OtherUS DEPT OF LABOR OWCP
PA22210OtherHEALTH PARTNERS
PA1413937OtherALL BLUE SHIELDS, AMERIHL
PA93900OtherAMERICHOICE OF PENN