ACTIVE SPINE & REHAB, LLC


Address: 802 Cromwell Park Dr, Glen Burnie, MD 21061-2563
Phone: 4109708190

ACTIVE SPINE & REHAB, LLC (NPI# 1427609429) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1427609429
Entity Type Organization
Organization Name ACTIVE SPINE & REHAB, LLC
Practice Address 802 Cromwell Park Dr
Glen Burnie
MD 21061-2563
Mailing Address 10753 Birmingham Way
Woodstock
MD 21163-1535
Practice Telephone 4109708190
Practice Fax Number 4103138314
Mailing Telephone 4109708190
Enumeration Date 2019-09-23
Last Update Date 2019-09-23
Authorized Official Name PATRICK MURRAY (DIRECTOR OF REVENUE CYCLE)
Authorized Official Telephone 4109708190
Is Organization Subpart N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 261QM1300X Clinic/Center
Specialization: Multi-Specialty
Ambulatory Health Care Facilities

Office Location

Street Address 802 CROMWELL PARK DR
City GLEN BURNIE
State MD
Zip Code 21061-2563

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1255780300 Rachel Cutts Physical Therapist 7711 Quarterfield Rd Ste C2, Glen Burnie, MD 21061 2016-06-09
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1023499548 Mary Bourbon Nurse Practitioner 1600 S. Cain Highway, Suite 401, Glen Burnie, MD 21061 2015-06-10
1972997724 Robert Oladeinde Physician Assistant 6934 Aviation Blvd Suite B, Glen Burnie, MD 21061 2015-03-18
1205248069 Cathy Qing He Anesthesiology 1600 Crain Hwy S Ste 301, Glen Burnie, MD 21061 2014-05-28
1477974764 Shannon Holder Nurse Practitioner 1916 Crain Hwy S Ste 2, Glen Burnie, MD 21061 2014-01-03
1629404207 Marla Ann Muha Physician Assistant 301 Hospital Dr # 803, Glen Burnie, MD 21061 2013-09-16
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Taxonomy Information

Taxonomy Code 261QM1300X
Grouping Ambulatory Health Care Facilities
Classification Clinic/Center
Specialization Multi-Specialty

Taxonomy Definition

Definition to come...

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NPI Name Taxonomy Address Enumeration
1255951372 Holistic Touch Healthcare LLC Clinic/Center 1412 Crain Hwy N Ste 3a, Glen Burnie, MD 21061-7000 2020-04-18
1194155127 Us Medgroup of New Jersey Pa Clinic/Center 811 Cromwell Park Dr, Ste. 104 -105, Glen Burnie, MD 21061-2566 2013-11-12

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Competitor

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City GLEN BURNIE
Zip Code 21061

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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