JACK G MCCULLOCH JR (NPI# 1790859585) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1790859585 |
| Entity Type | Organization |
| Organization Name | JACK G MCCULLOCH JR |
| Other Organization Name | MCCULLOCH'S WIDE SHOES |
| Practice Address |
685 S Brea Blvd Brea CA 92821-5308 |
| Practice Telephone | 7145296399 |
| Practice Fax Number | 7145292859 |
| Mailing Telephone | 7145296399 |
| Mailing Fax Number | 7145292859 |
| Enumeration Date | 2006-11-20 |
| Last Update Date | 2013-04-11 |
| Authorized Official Name | MRS. APRYL H MCCULLOCH (CO-OWNER) |
| Authorized Official Telephone | 7145296399 |
| Authorized Official Credential | C.PED. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 332B00000X | Durable Medical Equipment & Medical Supplies | Suppliers |
| Other Name | Type Code |
|---|---|
| McCulloch's Wide Shoes | Doing Business As Name - Organization |
| Street Address |
685 S BREA BLVD |
| City | BREA |
| State | CA |
| Zip Code | 92821-5308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043844921 | Christina Marie Iezza | Physical Medicine & Rehabilitation | 500 W. Central Ave, Suite B, Brea, CA 92821 | 2020-02-28 |
| 1962052068 | Joanne Chung | Behavioral Analyst | 3050 Saturn Street, #102, Brea, CA 92821 | 2019-09-19 |
| 1508336736 | Sonia Montez | Physical Therapy Assistant | Jump N Schout, 500 W Central Ave, Brea, CA 92821 | 2018-11-30 |
| 1215411921 | Eye View Optometry, Inc | Optometrist | 605 E. Imperial Hwy, Suite C, Brea, CA 92821 | 2018-09-18 |
| 1700395480 | Sheetal Patel | Registered Nurse | 955 W. Imperial Hwy., Suite 220, Brea, CA 92821 | 2017-09-25 |
| 1952827826 | Grace Cho | Occupational Therapist | 875 N Brea Blvd # 600, Brea, CA 92821 | 2017-08-22 |
| 1063959781 | Veronica Meza | Lactation Consultant, Non-RN | 551 Discovery Lane, #115, Brea, CA 92821 | 2017-01-20 |
| 1780045815 | Audrey Alva | Specialist/Technologist | 460 W. Lambert Road, Brea, CA 92821 | 2016-03-17 |
| 1558734921 | Eun Kim Chiropractic Inc | Chiropractor | 411 Atlas Street, Suite A, Brea, CA 92821 | 2015-11-07 |
| 1053784512 | Caremore Health Plan | Nurse Practitioner | 420 W. Central Avenue #a, Brea, CA 92821 | 2015-11-05 |
| Find all providers in zip 92821 | ||||
| Taxonomy Code | 332B00000X |
| Grouping | Suppliers |
| Classification | Durable Medical Equipment & Medical Supplies |
| A supplier of medical equipment such as respirators, wheelchairs, home dialysis systems, or monitoring systems, that are prescribed by a physician for a patient’s use in the home and that are usable for an extended period of time. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1639793524 | Sg Homecare, Inc | Durable Medical Equipment & Medical Supplies | 3350 E Birch St Ste 108, Brea, CA 92821-6290 | 2020-06-05 |
| 1013576792 | Motion Complex Rehab | Durable Medical Equipment & Medical Supplies | 555 W Lambert Rd Ste L, Brea, CA 92821-3917 | 2019-06-06 |
| 1033687272 | Bruce Sangho Lee | Durable Medical Equipment & Medical Supplies | 534 Cardinal St, Brea, CA 92823-1005 | 2018-11-06 |
| 1740757897 | Medical Oxygen & Supplies Inc | Durable Medical Equipment & Medical Supplies | 569 Mercury Ln, Brea, CA 92821-4837 | 2018-10-26 |
| 1528533841 | Billions Centuries Inc | Durable Medical Equipment & Medical Supplies | 826 Lantana Ave, Brea, CA 92821-6445 | 2018-10-13 |
| 1932426194 | Npr Biomedical Inc. | Durable Medical Equipment & Medical Supplies | 351 North Berry St, Brea, CA 92821 | 2010-04-28 |
| 1699944512 | Jacob John Gomez | Durable Medical Equipment & Medical Supplies | 1220 Pioneer St, Unit B, Brea, CA 92821-3715 | 2008-02-25 |
| 1235288150 | Medical Product Specialist | Durable Medical Equipment & Medical Supplies | 785 Challenger St, Brea, CA 92821-2948 | 2007-01-09 |
| 1871603662 | Thrifty Payless Inc | Durable Medical Equipment & Medical Supplies | 405 West Imperial Highway, Brea, CA 92821-4818 | 2006-08-30 |
| 1770591356 | Lori Schwartz | Durable Medical Equipment & Medical Supplies | 1050 W Central Ave Ste D, Brea, CA 92821-2200 | 2006-08-03 |
| Find all providers in BREA | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.