Basic Information
| Provider Information | |||||||||
| NPI: | 1043282882 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NEUROSURGICAL ASSOCIATES OF NORTHWEST OHIO LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 636320 | ||||||||
| Address2: | |||||||||
| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452630001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8005144390 | ||||||||
| FaxNumber: | 4194235107 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 S MAIN ST | ||||||||
| Address2: | |||||||||
| City: | FINDLAY | ||||||||
| State: | OH | ||||||||
| PostalCode: | 458401214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194235107 | ||||||||
| FaxNumber: | 4194235550 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 01/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | CYTLAK | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT OF FINANCE | ||||||||
| AuthorizedOfficialTelephone: | 4194235497 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BLANCHARD VALLEY HEALTH SYSTEM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 2595544 | 05 | OH | MEDICAID |