MEDICARE: MEDINA CARDIOVASCULAR ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RC0000X	Cardiovascular Disease Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	CA2551	OTHER	OH	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1700816824
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDINA CARDIOVASCULAR ASSOCIATES INC

Provider Business Mailing Address
First Line	:	970 E WASHINGTON ST STE 2E
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2181
Country	:	US
Telephone Number	:	330-722-8707
Fax Number	:	330-723-5679

Provider Business Practice Location Address
First Line	:	970 E WASHINGTON ST STE 2E
Second Line	:
City	:	MEDINA
State	:	OH
Zip	:	44256-2181
Country	:	US
Telephone Number	:	330-722-8707
Fax Number	:	330-723-5679

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. THAN M JAIN
Credential	:	MD
Telephone Number	:	330-722-8707

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	09/29/2011

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