Healthcare Provider Details

I. General information

NPI: 1689801631
Provider Name (Legal Business Name): MEDICGAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

81812 DR CARREON BLVD F
INDIO CA
92201-5594
US

IV. Provider business mailing address

225 S LAKE AVE 535
PASADENA CA
91101-3005
US

V. Phone/Fax

Practice location:
  • Phone: 760-775-2225
  • Fax: 760-775-2377
Mailing address:
  • Phone: 626-204-6747
  • Fax: 626-396-0851

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA81737
License Number StateCA

VIII. Authorized Official

Name: DR. PEER O THEOBALD
Title or Position: PRESIDENT
Credential: M.D.
Phone: 760-989-0507