Provider Demographics
NPI:1164855904
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:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDVE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-444-2296
Mailing Address - Street 1:9500 EUCLID AVENUE JJ10
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44195-2170
Mailing Address - Country:US
Mailing Address - Phone:216-445-2357
Mailing Address - Fax:216-445-0025
Practice Address - Street 1:1000 E. WASHINGTON STR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-721-5490
Practice Address - Fax:330-721-5495
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE CLEVELAND CLINIC FOUNDATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-08-15
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0223356003336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy