NPIMap

Organization Active NPI

Memorialcare Medical Group, Inc.

Doing business as MemorialCare Medical Group - Mission Viejo - Crown Valley Parkway

  • Non-Pharmacy Dispensing Site
  • Mission Viejo, CA
National Provider Identifier
1194866772
Registry record updated Apr 3, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Non-Pharmacy Dispensing SiteTaxonomy code 332900000X
License
A31048 Issued in CA
Legal business name
MEMORIALCARE MEDICAL GROUP, INC.
Doing business as
MemorialCare Medical Group - Mission Viejo - Crown Valley Parkway
Practice address
26991 Crown Valley Pkwy
Mission Viejo, CA 92691-6528
Phone
(949) 582-2002
NPI assigned
Feb 8, 2007
Last updated
Apr 3, 2013By the provider in NPPES
Organization subpart
Yes
Parent organization
MEDVANTX, INC.As reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 3, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kenny Heine
Title
VP of Operations
Phone
(858) 625-2990

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Non-Pharmacy Dispensing Site 332900000X A31048 CA Primary

Addresses

Primary practice location

26991 Crown Valley Pkwy
Mission Viejo, CA 92691-6528

Mailing address

5626 Oberlin Dr
Suite 110
San Diego, CA 92121-1705
Phone (858) 625-2990

Other names 1

  • MemorialCare Medical Group - Mission Viejo - Crown Valley Parkway Doing business as

National Provider Directory

National Provider Directory
Tax ID family
BPMG - Costa Mesa9 organizations share this tax ID, including this one
Part of
Medvantx Inc

Other organizations with this tax ID 8

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170892800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1364947200000",
    "number": "1194866772",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705",
            "telephone_number": "858-625-2990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "26991 CROWN VALLEY PKWY",
            "city": "MISSION VIEJO",
            "state": "CA",
            "postal_code": "926916528",
            "telephone_number": "949-582-2002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEMORIALCARE MEDICAL GROUP, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-08",
        "last_updated": "2013-04-03",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "VP OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "A31048",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MemorialCare Medical Group - Mission Viejo - Crown Valley Parkway",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Mission Viejo, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.