Provider Demographics
NPI:1194822320
Name:METRO-MED, INC. - LOS ALAMITOS
Entity Type:Organization
Organization Name:METRO-MED, INC. - LOS ALAMITOS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:YAEGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-840-9090
Mailing Address - Street 1:8999 GEMINI PKWY STE 220
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43240-2250
Mailing Address - Country:US
Mailing Address - Phone:614-573-9075
Mailing Address - Fax:614-568-5290
Practice Address - Street 1:10841 NOEL ST
Practice Address - Street 2:STE. 108, 103
Practice Address - City:LOS ALAMITOS
Practice Address - State:CA
Practice Address - Zip Code:90720-2597
Practice Address - Country:US
Practice Address - Phone:714-761-9761
Practice Address - Fax:714-761-8455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100347332B00000X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME03175FMedicaid
CAZZZ133182OtherBLUE SHIELD PROVIDER #
CA4201420001Medicare NSC