Organization Active NPI

Spine Center of PA LLC

  • Interventional Pain Medicine Physician
  • Erie, PA
National Provider Identifier
1104465681
Registry record updated Dec 31, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
SPINE CENTER OF PA LLC
Practice address
2374 Village Common Dr Ste 100
Erie, PA 16506-7201
Phone
(814) 833-7246
NPI assigned
Dec 31, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2019

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Anish Patel, MD
Title
Owner
Phone
(301) 620-0012

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pain Medicine (Physical Medicine & Rehabilitation) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 2081P2900X
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

2374 Village Common Dr Ste 100
Erie, PA 16506-7201

Mailing address

3060 Williams Dr Ste 510
Fairfax, VA 22031-4648
Phone (703) 789-1929

National Provider Directory

National Provider Directory

Locations

3060 Williams Dr
Ste 510
Fairfax, VA 22031

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1577750400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1577750400000",
    "number": "1104465681",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 WILLIAMS DR STE 510",
            "city": "FAIRFAX",
            "state": "VA",
            "postal_code": "220314648",
            "telephone_number": "703-789-1929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2374 VILLAGE COMMON DR STE 100",
            "city": "ERIE",
            "state": "PA",
            "postal_code": "165067201",
            "telephone_number": "814-833-7246"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPINE CENTER OF PA LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-12-31",
        "last_updated": "2019-12-31",
        "certification_date": "2019-12-31",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "ANISH",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "301-620-0012",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Erie, PA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.