# MC MEDICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Walmart Health
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821708975
- **Authorized official:** SOUJANYA PULLURU (OWNER)
- **Authorized official phone:** (630) 545-4046

## Contact information

- **Practice address:** 4250 PHILIPS HWY UNIT 100, JACKSONVILLE, FL 32207-6730
- **Practice address phone:** (904) 916-0578
- **Mailing address:** 702 SW 8TH ST \# MS 0445, BENTONVILLE, AR 72716-0445
- **Mailing address phone:** (479) 258-2080

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 11/30/2022
- **Last updated:** 11/30/2022