Provider Demographics
NPI:1982768362
Name:SPINAL CARE PAIN ASSOCIATES P C
Entity Type:Organization
Organization Name:SPINAL CARE PAIN ASSOCIATES P C
Other - Org Name:SPINAL CARE PAIN CRNA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISS
Authorized Official - Suffix:
Authorized Official - Credentials:MBA MS
Authorized Official - Phone:215-462-6600
Mailing Address - Street 1:2410 S BROAD ST
Mailing Address - Street 2:3RD FLR
Mailing Address - City:PHILA
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 FLR
Practice Address - City:PHILA
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:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA2133384000OtherALL IBC PRODUCTS
PA2133384000OtherALL IBC PRODUCTS