Provider Demographics
NPI:1174525620
Name:MEDINA EMERGENCY ASSOCIATES LTD
Entity type:Organization
Organization Name:MEDINA EMERGENCY ASSOCIATES LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:D
Authorized Official - Last Name:BOWEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-725-1000
Mailing Address - Street 1:PO BOX 30790
Mailing Address - Street 2:MEDINA EMERGENCY ASSOCIATES LTD
Mailing Address - City:MIDDLEBURG HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44130-0790
Mailing Address - Country:US
Mailing Address - Phone:866-266-8189
Mailing Address - Fax:330-654-9086
Practice Address - Street 1:1000 E WASHING AVE
Practice Address - Street 2:
Practice Address - City:MEDINA
Practice Address - State:OH
Practice Address - Zip Code:44256
Practice Address - Country:US
Practice Address - Phone:330-654-1185
Practice Address - Fax:330-654-9086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-15
Last Update Date:2008-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2395546Medicaid
OHME9332901Medicare ID - Type Unspecified