Organization
DOCTORS PAIN CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY LEE NEUENDORF D.O. (PRESIDENT/CEO/OWNER)
(330) 629-2888
Entity
Organization
Contact information
Practice address
1011 BOARDMAN CANFIELD RD, BOARDMAN, OH 44512
(330) 629-2888
(330) 259-9625
Mailing address
1011 BOARDMAN CANFIELD RD, BOARDMAN, OH 44512-4226
(330) 629-2888
(330) 629-2946
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
101YM0800X
Mental Health Counselor
—
—
101YP2500X
Professional Counselor
—
—
1041C0700X
Clinical Social Worker
—
—
207L00000X
Anesthesiology Physician
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
—
—
364SP0808X
Psychiatric/Mental Health Clinical Nurse Specialist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1018803700001
—
PA
01
—
111998
HIGHMARK
PA
01
—
1954815
HIGHMARK BC/BS
PA
05
—
2462154
—
PA
05
—
2469154
—
OH
01
—
340892
ANTHEM
OH
Enumeration date
05/22/2006
Last updated
08/21/2018
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