FAIRWOOD SPINE AND PAIN CENTER - NPI NUMBER 1235484353

Summary

Provider Name: FAIRWOOD SPINE AND PAIN CENTER

NPI Number: 1235484353

Clasification: Pain Medicine (208VP0014X)

Specialization: Interventional Pain Medicine

Address:
6911 LAUREL BOWIE RD
STE 212
BOWIE, MD
ZIP 20715

Phone Number: (301) 776-6500



Detailed Information

FAIRWOOD SPINE AND PAIN CENTER is an interventional pain medicine physician in Bowie, MD. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. The assigned NPI number for this provider is 1235484353 and is registered as an organization entity type and is a multiple single specialty group.

The provider's business address is:

6911 LAUREL BOWIE RD
STE 212
BOWIE, MD
ZIP 20715-712
Phone: (301) 776-6500
Fax: (301) 965-0919

The provider's authorized official is Joseph Oppong .
The authorized official title is Co-director/president and has the following contact phone number (301) 776-6500.

The enumeration date for this NPI number is 7/15/2012 and was last updated on 12/2/2014.

Map - Location of Practice

Similar Providers

NPI Provider Name / Taxonomy
1023309010 CENTER FOR PAIN MANAGEMENT, LLC
Pain Medicine (Interventional Pain Medicine)
1336230416 DR. CAREY-WALTER F CLOSSON, M.D.
Pain Medicine (Interventional Pain Medicine)





Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 208VP0014X Pain Medicine Interventional Pain Medicine D0072898 MD No
2 208VP0014X Pain Medicine Interventional Pain Medicine D0066706 MD Yes

NPI Record

No. Field Name Field Value Field Definition 1
1 NPI 1235484353 The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
2 Entity Type Code 2 Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
3 Employer Identification Number EIN The Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
4 Provider Organization Name Legal Business Name FAIRWOOD SPINE AND PAIN CENTER The name of the organization provider. If the provider is an organization, this is the legal business name.
5 Provider First Line Business Practice Location Address 6911 LAUREL BOWIE RD The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
6 Provider Second Line Business Practice Location Address STE 212 The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
7 Provider Business Practice Location Address City Name BOWIE The city name in the location address of the provider being identified.
8 Provider Business Practice Location Address State Name MD The State code in the location of the provider being identified.
9 Provider Business Practice Location Address Postal Code 207151712 The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
10 Provider Business Practice Location Address Country Code If outside U S US The country code in the location address of the provider being identified.
11 Provider Business Practice Location Address Telephone Number 3017766500 The telephone number associated with the location address of the provider being identified.
12 Provider Business Practice Location Address Fax Number 3019650919 The fax number associated with the location address of the provider being identified.
13 Provider Enumeration Date 7/15/2012 The date the provider was assigned a unique identifier (assigned an NPI).
14 Last Update Date 12/2/2014 The date that a record was last updated or changed.
15 Authorized Official Last Name OPPONG The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
16 Authorized Official First Name JOSEPH The first name of the authorized official.
17 Authorized Official Title or Position CO-DIRECTOR/PRESIDENT The title or position of the authorized official.
18 Authorized Official Telephone Number 3017766500 The 10-position telephone number of the authorized official.
19 Healthcare Provider Taxonomy Code 1 208VP0014X Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
20 Provider License Number 1 D0072898 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
21 Provider License Number State Code 1 MD The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
22 Healthcare Provider Primary Taxonomy Switch 1 N
23 Healthcare Provider Taxonomy Code 2 208VP0014X
24 Provider License Number 2 D0066706 The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
25 Provider License Number State Code 2 MD The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
26 Healthcare Provider Primary Taxonomy Switch 2 Y
27 Is Organization Subpart N
28 Authorized Official Name Suffix Text JR.
29 Authorized Official Credential Text M.D.
30 Healthcare Provider Taxonomy Group 1 193400000X MULTIPLE SINGLE SPECIALTY GROUP
31 Healthcare Provider Taxonomy Group 2 193400000X MULTIPLE SINGLE SPECIALTY GROUP

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This page was last updated on: 3/10/2015

(1) Field Definition Source-. Federal Register / Vol. 69, No. 15 / Friday, January 23, 2004 / Rules and Regulations - Part II Department of Health and Human Services Office of the Secretary 45 CFR Part 162 HIPAA Administrative Simplification: Standard Unique Health Identifier for Health Care Providers; Final Rule

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