Provider Demographics
NPI:1194147249
Name:MEDYCALL, INC
Entity type:Organization
Organization Name:MEDYCALL, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:C
Authorized Official - Last Name:CLOUD
Authorized Official - Suffix:III
Authorized Official - Credentials:MPH
Authorized Official - Phone:323-301-2178
Mailing Address - Street 1:PO BOX 162
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90213-0162
Mailing Address - Country:US
Mailing Address - Phone:323-301-2178
Mailing Address - Fax:866-844-4712
Practice Address - Street 1:250 S LA CIENEGA BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3302
Practice Address - Country:US
Practice Address - Phone:323-301-2178
Practice Address - Fax:866-844-4712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-08
Last Update Date:2014-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC3549969261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3126OtherAAAASF