Center for Spine Interventions ASC 1 LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

CENTER FOR SPINE INTERVENTIONS ASC 1 LLC

Practice address

4586 Timber Ridge Dr Ste 141
Douglasville, GA 30135-7517

Phone

(678) 813-2741

Fax

(770) 575-3912

NPI assigned

Aug 6, 2013

Organization subpart

No

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

Authorized official

Name

Janice Raya

Title

Office Manager

Phone

(678) 813-2741

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

Listed as

Center for Spine Intervention ASC 1 LLCCCN 11C0001411

Medicare certification status

ActiveFrom the Provider of Services file

Locations

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

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626912000000",
    "number": "1801228481",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2713 CHARLES HARDY PKWY STE 212",
            "city": "DALLAS",
            "state": "GA",
            "postal_code": "301579445",
            "telephone_number": "678-813-2741",
            "fax_number": "770-575-3912"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4586 TIMBER RIDGE DR STE 141",
            "city": "DOUGLASVILLE",
            "state": "GA",
            "postal_code": "301357517",
            "telephone_number": "678-813-2741",
            "fax_number": "770-575-3912"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTER FOR SPINE INTERVENTIONS ASC 1 LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-08-06",
        "last_updated": "2021-07-22",
        "certification_date": "2021-07-22",
        "status": "A",
        "authorized_official_last_name": "RAYA",
        "authorized_official_first_name": "JANICE",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "678-813-2741"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Douglasville, GA
• Providers in Douglasville, GA by specialty
• Ambulatory Surgical Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.