MC Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MC MEDICAL LLC

Doing business as

Walmart Health

Practice address

7209 N Prospect Avenue
Gladstone, MO 64119

Phone

(479) 258-2080

NPI assigned

Sep 8, 2023

Organization subpart

No

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

Authorized official

Name

Richard Henry

Title

Enrollment Manager

Phone

(479) 258-2080

Specialties & licenses 7

Addresses

Other names 1

• Walmart Health Doing business as

Tax ID family

MC Medical LLC3 organizations share this tax ID, including this one

Other organizations with this tax ID 2

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

• MC Medical LLC

  dba Walmart Health

  • General Practice Physician
  • Oklahoma City, OK
  • NPI 1538945399
  NPD tax ID
• MC Medical LLC

  • General Practice Physician
  • Middleburg, FL
  • NPI 1851042238
  NPD tax ID

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

{
    "created_epoch": "1694131200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703030400000",
    "number": "1073390696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST # MS 0445",
            "city": "BENTONVILLE",
            "state": "AR",
            "postal_code": "727166209",
            "telephone_number": "479-258-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7209 N PROSPECT AVENUE",
            "city": "GLADSTONE",
            "state": "MO",
            "postal_code": "64119",
            "telephone_number": "479-258-2080"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "10302 E Highway 350",
            "address_purpose": "LOCATION",
            "city": "Raytown",
            "state": "MO",
            "postal_code": "64138",
            "country_code": "US",
            "telephone_number": "479-258-2080",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1701 W 133rd St Ste 100",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641451631",
            "country_code": "US",
            "telephone_number": "816-447-3968",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "11601 E US Highway 40 Ste 100",
            "address_purpose": "LOCATION",
            "city": "Kansas City",
            "state": "MO",
            "postal_code": "641331908",
            "country_code": "US",
            "telephone_number": "479-258-2080",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "MC MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-09-08",
        "last_updated": "2023-12-20",
        "certification_date": "2023-12-18",
        "status": "A",
        "authorized_official_last_name": "HENRY",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "ENROLLMENT MANAGER",
        "authorized_official_telephone_number": "479-258-2080"
    },
    "taxonomies": [
        {
            "code": "101Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Counselor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "104100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Social Worker",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "106H00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Marriage & Family Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207R00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Health",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "Walmart Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Dixie Sue Manroe, FNP BC
• Shelby Markum, LSCSW, LCSW
• Douglass Eugene Martin, ED.D.
• Emily Kay Marx, D.D.S.
• April J Matusiak
• Kathryn R McCampbell, OD
• Chris M McClenney, DC
• Karen E Mees, LPC
• Melo Enterprises LLC
• Scott Timothy Melton, DDS

• General Practice Physician in Gladstone, MO
• Providers in Gladstone, MO by specialty
• General Practice Physician in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2023; 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.