Healthcare Provider Details

I. General information

NPI: 1588718258
Provider Name (Legal Business Name): MEDINA GENERAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 E WASHINGTON ST
MEDINA OH
44256-2170
US

IV. Provider business mailing address

1798 HAMPTON KNOLL DR
AKRON OH
44313-9162
US

V. Phone/Fax

Practice location:
  • Phone: 330-725-1000
  • Fax:
Mailing address:
  • Phone: 330-338-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License NumberAT002068
License Number StateOH

VIII. Authorized Official

Name: MR. KEITH M MCFARLANE
Title or Position: CERTIFIED ATHLETIC TRAINER
Credential: ATC
Phone: 330-725-1000