Healthcare Provider Details

I. General information

NPI: 1770609745
Provider Name (Legal Business Name): MINGO MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 11/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MCLISTER AVE
MINGO JUNCTION OH
43938-1260
US

IV. Provider business mailing address

201 MCLISTER AVE
MINGO JUNCTION OH
43938-1260
US

V. Phone/Fax

Practice location:
  • Phone: 740-535-0555
  • Fax: 740-535-2020
Mailing address:
  • Phone: 740-535-0555
  • Fax: 740-535-2020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number35041816J
License Number StateOH

VIII. Authorized Official

Name: DR. WILLIAM E JOHNS
Title or Position: OWNER
Credential: M.D.
Phone: 740-535-0555