Provider Demographics
NPI:1790049872
Name:OHIO NORTH EAST HEALTH SYSTEMS INC
Entity Type:Organization
Organization Name:OHIO NORTH EAST HEALTH SYSTEMS INC
Other - Org Name:KIDZ 1ST PEDIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:DWINNELLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-747-9551
Mailing Address - Street 1:726 WICK AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44505-2827
Mailing Address - Country:US
Mailing Address - Phone:330-747-9551
Mailing Address - Fax:330-884-6120
Practice Address - Street 1:1821 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6627
Practice Address - Country:US
Practice Address - Phone:330-392-7000
Practice Address - Fax:330-884-6120
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-03
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0068428Medicaid