Provider Demographics
NPI:1073893046
Name:THE MEDINA CLINIC, INCORPORATED
Entity Type:Organization
Organization Name:THE MEDINA CLINIC, INCORPORATED
Other - Org Name:THE MEDINA CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WAEL
Authorized Official - Middle Name:SAYED
Authorized Official - Last Name:MOURAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-214-5548
Mailing Address - Street 1:13013 FULLER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:GRANDVIEW
Mailing Address - State:MO
Mailing Address - Zip Code:64030-2687
Mailing Address - Country:US
Mailing Address - Phone:816-214-5548
Mailing Address - Fax:816-326-0990
Practice Address - Street 1:13013 FULLER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:GRANDVIEW
Practice Address - State:MO
Practice Address - Zip Code:64030-2687
Practice Address - Country:US
Practice Address - Phone:816-214-5548
Practice Address - Fax:816-326-0990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-23
Last Update Date:2011-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care