MC Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MC MEDICAL LLC

Doing business as

Walmart Health

Practice address

3820 State Highway 64 W
Tyler, TX 75704-6924

Phone

(903) 594-4761

Fax

(903) 526-0280

NPI assigned

Jul 21, 2014

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 identifiers 1

Other names 1

• Walmart Health Doing business as

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

{
    "created_epoch": "1405900800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669075200000",
    "number": "1326455577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "702 SW 8TH ST",
            "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": "3820 STATE HIGHWAY 64 W",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757046924",
            "telephone_number": "903-594-4761",
            "fax_number": "903-526-0280"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-07-21",
        "last_updated": "2022-11-22",
        "certification_date": "2022-11-22",
        "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": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "358648ZHTM",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Walmart Health",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Hilay Jarman Mayo, SPEECH PATHOLOGIST
• Tera Mayo
• Mazzare Medical, PLLC
• Mark A Mazzare, M.D.
• Brenda Tsehainzu Mbipeh, PHARMD
• Natalie Kay McAbee, O.D.
• James D McAndrew, M.D.
• Deadra McArthur Jackson
• Hannah McBride
• Emily K McBroom

• General Practice Physician in Tyler, TX
• Providers in Tyler, TX by specialty
• General Practice Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 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.