Provider Demographics
NPI:1265701650
Name:ADVANCED SPINE CENTER
Entity type:Organization
Organization Name:ADVANCED SPINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:RIMLAWI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-395-3928
Mailing Address - Street 1:PO BOX 670531
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75367-0531
Mailing Address - Country:US
Mailing Address - Phone:214-838-3573
Mailing Address - Fax:
Practice Address - Street 1:2430 VICTORY PARK LN
Practice Address - Street 2:STE 2001
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-7709
Practice Address - Country:US
Practice Address - Phone:214-838-3573
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2011-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7877207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty