| Ontario Medical Spine And Joint Llc | |
|
2262 Stumbo Rd Ontario OH 44906-3804 | |
| (419) 747-9355 | |
| (419) 529-8525 |
| Full Name | Ontario Medical Spine And Joint Llc |
|---|---|
| Speciality | General Practice |
| Location | 2262 Stumbo Rd, Ontario, Ohio |
| Authorized Official Name and Position | Heather Lynn Simpson (MANAGER) |
| Authorized Official Contact | 4197479355 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Ontario Medical Spine And Joint Llc 2262 Stumbo Rd Ontario OH 44906-3804 Ph: (419) 747-9355 | Ontario Medical Spine And Joint Llc 2262 Stumbo Rd Ontario OH 44906-3804 Ph: (419) 747-9355 |
| NPI Number | 1053928499 |
|---|---|
| Provider Enumeration Date | 09/29/2020 |
| Last Update Date | 12/11/2020 |
| Medicare PECOS PAC ID | 3173936002 |
|---|---|
| Medicare Enrollment ID | O20210119002634 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053928499 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Kelly M Hriesik |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1205308657 PECOS PAC ID: 8022356823 Enrollment ID: I20190220000846 |
| Provider Name | Evangeline Mahima Standridge |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174121156 PECOS PAC ID: 9032523725 Enrollment ID: I20210120001297 |
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