Provider Demographics
NPI:1124049101
Name:NEO SURGICAL ASSOCIATES INC
Entity type:Organization
Organization Name:NEO SURGICAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:CARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-823-8452
Mailing Address - Street 1:270 E STATE ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ALLIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:44601-4957
Mailing Address - Country:US
Mailing Address - Phone:330-823-8452
Mailing Address - Fax:330-823-8491
Practice Address - Street 1:270 E STATE ST
Practice Address - Street 2:SUITE 120
Practice Address - City:ALLIANCE
Practice Address - State:OH
Practice Address - Zip Code:44601-4957
Practice Address - Country:US
Practice Address - Phone:330-823-8452
Practice Address - Fax:330-823-8491
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-00-6856208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2084640Medicaid
OHNE9346181Medicare ID - Type Unspecified