Provider Demographics
NPI:1023385598
Name:MEDCAIR LLC
Entity Type:Organization
Organization Name:MEDCAIR LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BROOK
Authorized Official - Middle Name:
Authorized Official - Last Name:EPPERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-502-4448
Mailing Address - Street 1:1906 CAMINO DE LA COSTA
Mailing Address - Street 2:STE A
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277
Mailing Address - Country:US
Mailing Address - Phone:888-502-4448
Mailing Address - Fax:888-497-8544
Practice Address - Street 1:1906 CAMINO DE LA COSTA
Practice Address - Street 2:STE A
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277
Practice Address - Country:US
Practice Address - Phone:888-502-4448
Practice Address - Fax:888-497-8544
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDCAIR LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-28
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA261QS1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic