Provider Demographics
NPI:1700816824
Name:MEDINA CARDIOVASCULAR ASSOCIATES INC
Entity Type:Organization
Organization Name:MEDINA CARDIOVASCULAR ASSOCIATES INC
Other - Org Name:T M JAIN MD INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:JAIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-722-8707
Mailing Address - Street 1:970 E WASHINGTON ST STE 2E
Mailing Address - Street 2:
Mailing Address - City:MEDINA
Mailing Address - State:OH
Mailing Address - Zip Code:44256-2181
Mailing Address - Country:US
Mailing Address - Phone:330-722-8707
Mailing Address - Fax:330-723-5679
Practice Address - Street 1:970 E WASHINGTON ST STE 2E
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256-2181
Practice Address - Country:US
Practice Address - Phone:330-722-8707
Practice Address - Fax:330-723-5679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2011-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2401458Medicaid
OHCA2551OtherRAILROAD MEDICARE
OHCA2551OtherRAILROAD MEDICARE