Basic Information
| Provider Information | |||||||||
| NPI: | 1205279379 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ONTARIO FAMILY MEDICINE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 269 PORTLAND WAY S | ||||||||
| Address2: | |||||||||
| City: | GALION | ||||||||
| State: | OH | ||||||||
| PostalCode: | 448332312 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4194684841 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2007 W 4TH ST | ||||||||
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| City: | ONTARIO | ||||||||
| State: | OH | ||||||||
| PostalCode: | 449061787 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4195296195 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/09/2013 | ||||||||
| LastUpdateDate: | 04/09/2013 | ||||||||
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| AuthorizedOfficialLastName: | MORASKO | ||||||||
| AuthorizedOfficialFirstName: | JEROME | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 4194684841 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | GALION COMMUNITY HOSPITAL | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.