1316586670 NPI number — COUNTY OF MEDINA AUDITOR

Table of content: (NPI 1316586670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316586670 NPI number — COUNTY OF MEDINA AUDITOR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COUNTY OF MEDINA AUDITOR
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MEDINA COUNTY HEALTH DEPARTMENT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1316586670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4800 LEDGEWOOD DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEDINA
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44256-7666
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
185 WADSWORTH RD STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WADSWORTH
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44281-9585
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-723-9688
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/03/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WASOWSKI
Authorized Official First Name:
KRISTA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
HEALTH COMMISSIONER
Authorized Official Telephone Number:
330-723-9688

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)