Provider Demographics
NPI:1205279379
Name:ONTARIO FAMILY MEDICINE
Entity type:Organization
Organization Name:ONTARIO FAMILY MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:
Authorized Official - Last Name:MORASKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:419-468-4841
Mailing Address - Street 1:269 PORTLAND WAY S
Mailing Address - Street 2:
Mailing Address - City:GALION
Mailing Address - State:OH
Mailing Address - Zip Code:44833-2312
Mailing Address - Country:US
Mailing Address - Phone:419-468-4841
Mailing Address - Fax:
Practice Address - Street 1:2007 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1787
Practice Address - Country:US
Practice Address - Phone:419-529-6195
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GALION COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-04-09
Last Update Date:2013-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health