Provider Demographics
NPI:1932235801
Name:MC CARTY MEDICAL, LTD
Entity Type:Organization
Organization Name:MC CARTY MEDICAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMOREAUX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:909-790-2933
Mailing Address - Street 1:34461 YUCAIPA BLVD
Mailing Address - Street 2:
Mailing Address - City:YUCAIPA
Mailing Address - State:CA
Mailing Address - Zip Code:92399-2411
Mailing Address - Country:US
Mailing Address - Phone:909-790-2933
Mailing Address - Fax:909-790-1676
Practice Address - Street 1:34461 YUCAIPA BLVD
Practice Address - Street 2:
Practice Address - City:YUCAIPA
Practice Address - State:CA
Practice Address - Zip Code:92399-2411
Practice Address - Country:US
Practice Address - Phone:909-790-2933
Practice Address - Fax:909-790-1676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADME00633G332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADME00633GMedicaid
CA0295690001Medicare ID - Type UnspecifiedMEDICARE PROVIDER