MC Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MC MEDICAL LLC

Doing business as

Walmart Health

Practice address

12582 US Highway 19
Hudson, FL 34667

Phone

(479) 258-2080

NPI assigned

Dec 13, 2022

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 2

Addresses

Other names 1

• Walmart Health Doing business as

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

{
    "created_epoch": "1670889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670889600000",
    "number": "1083325757",
    "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": "727160445",
            "telephone_number": "479-258-2080"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12582 US HIGHWAY 19",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "34667",
            "telephone_number": "479-258-2080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-12-13",
        "last_updated": "2022-12-13",
        "certification_date": "2022-12-12",
        "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": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Richard Matos
• Ayman Matter, PT
• Jacqueline Maughan
• Saro Harry Mazmanian, DO
• Shaghayegh Mazoury, DO
• Gary Marc McClernan, DPM
• Christopher McCurdie
• Thomas M McDermott, PTA
• Laura McGee, DO
• Jeffrey Karr McMahon, BA

• General Practice Physician in Hudson, FL
• Providers in Hudson, FL by specialty
• General Practice Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 13, 2022; 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.