Provider Demographics
NPI:1902297112
Name:MINGO FAMILY PRACTICE
Entity Type:Organization
Organization Name:MINGO FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:VOSTATEK
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:740-535-8025
Mailing Address - Street 1:116 MCLISTER AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:MINGO JUNCTION
Mailing Address - State:OH
Mailing Address - Zip Code:43938-1259
Mailing Address - Country:US
Mailing Address - Phone:740-535-8025
Mailing Address - Fax:740-535-8079
Practice Address - Street 1:116 MCLISTER AVE
Practice Address - Street 2:SUITE B
Practice Address - City:MINGO JUNCTION
Practice Address - State:OH
Practice Address - Zip Code:43938-1259
Practice Address - Country:US
Practice Address - Phone:740-535-8025
Practice Address - Fax:740-535-8079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-10
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.16767-NP363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty