Provider Demographics
NPI:1467407338
Name:ADO HEALTH SERVICES INC
Entity Type:Organization
Organization Name:ADO HEALTH SERVICES INC
Other - Org Name:DOCTORS PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:NEUENDROF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-629-2888
Mailing Address - Street 1:1011 BOARDMAN-CANFIELD RD.
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-4226
Mailing Address - Country:US
Mailing Address - Phone:330-629-2888
Mailing Address - Fax:330-629-2946
Practice Address - Street 1:1011 BOARDMAN-CANFIELD RD.
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44512-4226
Practice Address - Country:US
Practice Address - Phone:330-629-2888
Practice Address - Fax:330-629-2946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2016-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207L00000X, 207LP2900X, 207LP2900X, 207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0071748100003Medicaid
OH36D2106526OtherCLIA WAIVER
OH0311344Medicaid
OH36D2106526OtherCLIA WAIVER
OH9921541Medicare PIN
PA0071748100003Medicaid