Medestate Inc.

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

License

00A0627550 Issued in CA

Legal business name

MEDESTATE INC.

Practice address

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

Phone

(707) 645-7229

Fax

(707) 645-7431

NPI assigned

Oct 16, 2006

Organization subpart

No

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

Authorized official

Name

Dr. Kenneth Richard Brooks, M.D.

Title

President / Ceo

Phone

(707) 645-7229

Specialties & licenses 1

Addresses

Other names 1

• ExcelCare Immediate Care Center Doing business as

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.

• Medestate Inc.

  • Urgent Care Clinic/Center
  • American Canyon, CA
  • NPI 1386959948
  NPD tax ID

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

{
    "created_epoch": "1160956800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325116800000",
    "number": "1508946476",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "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",
            "fax_number": "707-645-7431"
        },
        {
            "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",
            "fax_number": "707-645-7431"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDESTATE INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-16",
        "last_updated": "2011-12-29",
        "status": "A",
        "authorized_official_last_name": "BROOKS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "RICHARD",
        "authorized_official_title_or_position": "PRESIDENT / CEO",
        "authorized_official_telephone_number": "707-645-7229",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": "CA",
            "license": "00A0627550",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ExcelCare Immediate Care Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• McGrew Behavioral Health Services, Inc.
• Deborah M McGrew, MFT, BCBA-D
• Erin Kathleen McGuire, BCBA
• Marissa Medeiros
• Medestate Inc.
• Meredith Asprer-Beltran, DMD, Inc.
• Meridian Physical Therapy & Rehabilitation PC
• Lexus Miguel
• Lucia J Mijares, RPH
• Kira Montanari

• Urgent Care Clinic/Center in American Canyon, CA
• Providers in American Canyon, CA by specialty
• Urgent Care Clinic/Center in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 29, 2011; 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.