Provider Demographics
NPI:1609504794
Name:ONTARIO MINOR MEDICAL, LLC
Entity Type:Organization
Organization Name:ONTARIO MINOR MEDICAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:WINSLOW
Authorized Official - Last Name:PARSONS
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:419-775-5999
Mailing Address - Street 1:3401 PARK AVE W
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1047
Mailing Address - Country:US
Mailing Address - Phone:419-775-5999
Mailing Address - Fax:567-247-0527
Practice Address - Street 1:3401 PARK AVE W
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1047
Practice Address - Country:US
Practice Address - Phone:419-775-5999
Practice Address - Fax:567-247-0527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-08
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty