MEDICARE: ADDICTION OUTREACH CLINIC LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084A0401X	Addiction Medicine (Psychiatry & Neurology) Physician

General Provider Information

NPI Number	:	1356612261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADDICTION OUTREACH CLINIC LTD

Provider Business Mailing Address
First Line	:	755 BOARDMAN - CANFIELD ROAD
Second Line	:	SUITE K-1
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512
Country	:	US
Telephone Number	:	330-259-4849
Fax Number	:	330-629-2847

Provider Business Practice Location Address
First Line	:	819 MCKAY CT STE 102
Second Line	:
City	:	BOARDMAN
State	:	OH
Zip	:	44512-5771
Country	:	US
Telephone Number	:	330-259-4849
Fax Number	:	330-629-2847

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. NICHOLAS ANTHONY ATANASOFF
Credential	:	D.O.
Telephone Number	:	330-259-4849

Provider Enumeration Date	:	01/24/2012
Last Update Date	:	11/07/2023

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