Provider Demographics
NPI:1285794867
Name:NEO SURGICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:NEO SURGICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:F
Authorized Official - Last Name:HUDZIK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
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:2006-12-12
Last Update Date:2007-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-0068562086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2707039Medicaid
OHDF5242OtherRRB
OH2707039Medicaid