1194147249 NPI number — MEDYCALL, INC

Table of content: (NPI 1194147249)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194147249 NPI number — MEDYCALL, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDYCALL, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BEVERLY HILLS SURGERY CENTER OF EXCELLENCE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194147249
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 162
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90213-0162
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-301-2178
Provider Business Mailing Address Fax Number:
866-844-4712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 S LA CIENEGA BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-3302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-301-2178
Provider Business Practice Location Address Fax Number:
866-844-4712
Provider Enumeration Date:
01/08/2014

Additional Information

Authorized Official

Authorized Official Last Name:
CLOUD
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
C
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
323-301-2178

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  C3549969 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 3126 . This is a "AAAASF" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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