Provider Demographics
NPI:1285762583
Name:NORTHEASTERN OHIO NEUROSURGICAL ASSOCIATES
Entity type:Organization
Organization Name:NORTHEASTERN OHIO NEUROSURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:HOLLIS
Authorized Official - Middle Name:A
Authorized Official - Last Name:MIKER
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:440-975-5575
Mailing Address - Street 1:2785 SOM CENTER RD
Mailing Address - Street 2:
Mailing Address - City:WILLOUGHBY
Mailing Address - State:OH
Mailing Address - Zip Code:44094-9139
Mailing Address - Country:US
Mailing Address - Phone:440-975-5575
Mailing Address - Fax:440-944-0920
Practice Address - Street 1:2785 SOM CENTER RD
Practice Address - Street 2:
Practice Address - City:WILLOUGHBY
Practice Address - State:OH
Practice Address - Zip Code:44094-9139
Practice Address - Country:US
Practice Address - Phone:440-975-5575
Practice Address - Fax:440-944-0920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2468351Medicaid
OH2468351Medicaid