| Organization Name: | THE MEDINA CLINIC, INCORPORATED |
| NPI Number: | 1073893046 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | WAEL SAYED MOURAD (MEDICAL DIRECTOR) |
| Mailing Address: | 13013 Fuller Ave Suite A Grandview |
| State: | MO US |
| Postal Code: | 640302687 |
| Phone Number: | 8162145548 |
| Fax Number: | 8163260990 |
| NPI Enumeration Date: | 08/23/2011 |
| NPI Last Update Date: | 08/23/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |