Healthcare Provider Details

I. General information

NPI: 1174525620
Provider Name (Legal Business Name): MEDINA EMERGENCY ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2005
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHING AVE
MEDINA OH
44256
US

IV. Provider business mailing address

PO BOX 30790 MEDINA EMERGENCY ASSOCIATES LTD
MIDDLEBURG HEIGHTS OH
44130-0790
US

V. Phone/Fax

Practice location:
  • Phone: 330-654-1185
  • Fax: 330-654-9086
Mailing address:
  • Phone: 866-266-8189
  • Fax: 330-654-9086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KIM D BOWEN
Title or Position: PRESIDENT
Credential: MD
Phone: 330-725-1000