Provider Demographics
NPI:1982667044
Name:MEDICOOL, INC.
Entity Type:Organization
Organization Name:MEDICOOL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:YEAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-782-2200
Mailing Address - Street 1:20460 GRAMERCY PL
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-1513
Mailing Address - Country:US
Mailing Address - Phone:310-782-2200
Mailing Address - Fax:310-427-7274
Practice Address - Street 1:20460 GRAMERCY PL
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90501-1513
Practice Address - Country:US
Practice Address - Phone:310-782-2200
Practice Address - Fax:310-427-7274
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102899332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME02520FMedicaid
CADME02520FMedicaid