Provider Demographics
NPI:1699816884
Name:COUNTY OF MEDINA AUDITOR
Entity Type:Organization
Organization Name:COUNTY OF MEDINA AUDITOR
Other - Org Name:MEDINA COUNTY HEALTH DEPARTMENT
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BODJANAC
Authorized Official - Suffix:
Authorized Official - Credentials:DO
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:330-723-9688
Mailing Address - Fax:330-723-9697
Practice Address - Street 1:4800 LEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-7666
Practice Address - Country:US
Practice Address - Phone:330-723-9688
Practice Address - Fax:330-723-9697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2013-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0870919Medicaid
OHFV90911Medicare ID - Type Unspecified