Healthcare Provider Details

I. General information

NPI: 1194147249
Provider Name (Legal Business Name): MEDYCALL, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/08/2014
Last Update Date: 02/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 S LA CIENEGA BLVD SUITE 100
BEVERLY HILLS CA
90211-3302
US

IV. Provider business mailing address

PO BOX 162
BEVERLY HILLS CA
90213-0162
US

V. Phone/Fax

Practice location:
  • Phone: 323-301-2178
  • Fax: 866-844-4712
Mailing address:
  • Phone: 323-301-2178
  • Fax: 866-844-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberC3549969
License Number StateCA

VIII. Authorized Official

Name: MR. THOMAS C CLOUD III
Title or Position: ADMINISTRATOR
Credential: MPH
Phone: 323-301-2178