Provider Demographics
NPI:1316586670
Name:COUNTY OF MEDINA AUDITOR
Entity Type:Organization
Organization Name:COUNTY OF MEDINA AUDITOR
Other - Org Name:MEDINA COUNTY HEALTH DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH COMMISSIONER
Authorized Official - Prefix:
Authorized Official - First Name:KRISTA
Authorized Official - Middle Name:R
Authorized Official - Last Name:WASOWSKI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-723-9688
Mailing Address - Street 1:4800 LEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-7666
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 WADSWORTH RD STE C
Practice Address - Street 2:
Practice Address - City:WADSWORTH
Practice Address - State:OH
Practice Address - Zip Code:44281-9585
Practice Address - Country:US
Practice Address - Phone:330-723-9688
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-03
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)