NPIMap

Organization Active NPI

Medestate Inc.

  • Urgent Care Clinic/Center
  • American Canyon, CA
National Provider Identifier
1386959948
Registry record updated Aug 6, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Urgent Care Clinic/CenterTaxonomy code 261QU0200X
Legal business name
MEDESTATE INC.
Practice address
3431 Broadway St
Suite a-8
American Canyon, CA 94503-1228
Phone
(707) 645-7229
NPI assigned
Aug 6, 2010
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2010

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

Authorized official

Name
Dr. Kenneth R. Brooks, MDNPI 1528009685
Title
President/Ceo
Phone
(707) 745-2705

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Urgent Care Clinic/Center 261QU0200X Primary

Addresses

Primary practice location

3431 Broadway St
Suite a-8
American Canyon, CA 94503-1228

Mailing address

2012 Columbus Pkwy
Benicia, CA 94510-5400
Phone (707) 745-2705

Other names 1

  • ExcelCare Immediate Care Center Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Excelcare Immediate Care Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

2012 Columbus Pkwy
Benicia, CA 94510
Phone (707) 745-2705

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1281052800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1281052800000",
    "number": "1386959948",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2012 COLUMBUS PKWY",
            "city": "BENICIA",
            "state": "CA",
            "postal_code": "945105400",
            "telephone_number": "707-745-2705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3431 BROADWAY ST",
            "address_2": "SUITE A-8",
            "city": "AMERICAN CANYON",
            "state": "CA",
            "postal_code": "945031228",
            "telephone_number": "707-645-7229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDESTATE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-06",
        "last_updated": "2010-08-06",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "R.",
        "authorized_official_title_or_position": "PRESIDENT/CEO",
        "authorized_official_telephone_number": "707-745-2705",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ExcelCare Immediate Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in American Canyon, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2010; 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.