Provider Demographics
NPI:1497028534
Name:MEDIRECT, INC.
Entity Type:Organization
Organization Name:MEDIRECT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:C.E.O
Authorized Official - Prefix:
Authorized Official - First Name:AKOP
Authorized Official - Middle Name:JACK
Authorized Official - Last Name:DEMIRCHYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-545-1113
Mailing Address - Street 1:PO BOX 251479
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91225-1479
Mailing Address - Country:US
Mailing Address - Phone:818-545-1113
Mailing Address - Fax:888-420-3178
Practice Address - Street 1:412 W BROADWAY STE 210
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1297
Practice Address - Country:US
Practice Address - Phone:818-545-1113
Practice Address - Fax:888-420-3178
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization