Provider Demographics
NPI:1447317359
Name:COUNTY OF MEDINA
Entity type:Organization
Organization Name:COUNTY OF MEDINA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:HEALTH UNIT SUPERVISOR
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUENNINK
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:830-741-6191
Mailing Address - Street 1:3103 AVENUE G
Mailing Address - Street 2:
Mailing Address - City:HONDO
Mailing Address - State:TX
Mailing Address - Zip Code:78861-3532
Mailing Address - Country:US
Mailing Address - Phone:830-741-6191
Mailing Address - Fax:830-426-4202
Practice Address - Street 1:3103 AVENUE G
Practice Address - Street 2:
Practice Address - City:HONDO
Practice Address - State:TX
Practice Address - Zip Code:78861-3532
Practice Address - Country:US
Practice Address - Phone:830-741-6191
Practice Address - Fax:830-426-4202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0228108-01Medicaid
TX0228108-01Medicaid