Provider Demographics
NPI:1164785986
Name:MEDINA HOSPITAL
Entity Type:Organization
Organization Name:MEDINA HOSPITAL
Other - Org Name:CCF MEDINA AMBULATORY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:CARROLL
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, RPH
Authorized Official - Phone:216-448-5529
Mailing Address - Street 1:1000 E WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2170
Mailing Address - Country:US
Mailing Address - Phone:330-721-5152
Mailing Address - Fax:330-721-4916
Practice Address - Street 1:1000 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2170
Practice Address - Country:US
Practice Address - Phone:330-721-5152
Practice Address - Fax:330-721-4916
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CLEVELAND CLINIC FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-06-18
Last Update Date:2015-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-00373003336I0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336I0012XSuppliersPharmacyInstitutional Pharmacy