# RICKY D ST ONGE, MD LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1023372448
- **Authorized official:** DR. RICKY DONALD ST ONGE MD (SOLE MEMBER)
- **Authorized official phone:** (740) 645-3893

## Contact information

- **Practice address:** 5910 CLEVELAND AVE, COLUMBUS, OH 43231-6881
- **Practice address phone:** (614) 882-4343
- **Practice address fax:** (614) 882-4664
- **Mailing address:** 1255 N HAMILTON RD \# 216, GAHANNA, OH 43230-6785
- **Mailing address phone:** (740) 645-3893

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | 35-066328 | OH | Yes |

## Other

- **Enumeration date:** 06/29/2012
- **Last updated:** 11/12/2014