Provider Demographics
NPI:1447545827
Name:ADVANCED MEDICAL SPORTS AND SPINE, PLLC
Entity type:Organization
Organization Name:ADVANCED MEDICAL SPORTS AND SPINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:HALPERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:540-423-6239
Mailing Address - Street 1:2002 ORANGE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:CULPEPER
Mailing Address - State:VA
Mailing Address - Zip Code:22701-4170
Mailing Address - Country:US
Mailing Address - Phone:540-423-6239
Mailing Address - Fax:
Practice Address - Street 1:2002 ORANGE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:CULPEPER
Practice Address - State:VA
Practice Address - Zip Code:22701-4170
Practice Address - Country:US
Practice Address - Phone:540-423-6239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-14
Last Update Date:2014-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102202833208100000X, 2081P2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6700350001Medicare NSC