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Organization
MC MEDICAL LLC
Active
Organization
MC MEDICAL LLC
Active
Other names
Walmart Health
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD HENRY (ENROLLMENT MANAGER)
(479) 258-2080
Entity
Organization
Contact information
Practice address
2223 S LOOP 256, PALESTINE, TX 75801-4701
(903) 729-9501
(903) 729-9503
Mailing address
702 SW 8TH ST, BENTONVILLE, AR 72716-0445
(479) 204-8550
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
NULL
208D00000X
General Practice Physician
Primary
—
—
363L00000X
Nurse Practitioner
—
NULL
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
358648ZHTM
MEDICARE PTAN
TX
Enumeration date
07/10/2014
Last updated
03/28/2024
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