Provider Demographics
NPI:1578876355
Name:MEGASCOPE HEALTHCARE MEDICAL CORPORATION.
Entity Type:Organization
Organization Name:MEGASCOPE HEALTHCARE MEDICAL CORPORATION.
Other - Org Name:SANSA HEALTH CARE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TYRON
Authorized Official - Middle Name:CLEON
Authorized Official - Last Name:REECE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-330-0240
Mailing Address - Street 1:301 NORTH PRAIRIE AVENUE
Mailing Address - Street 2:STE 230
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4509
Mailing Address - Country:US
Mailing Address - Phone:310-330-0240
Mailing Address - Fax:310-330-9016
Practice Address - Street 1:301 NORTH PRAIRIE AVENUE
Practice Address - Street 2:STE 230
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4509
Practice Address - Country:US
Practice Address - Phone:310-330-0240
Practice Address - Fax:310-330-9016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X
CAA31509208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty