MC Medical LLC

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

MC MEDICAL LLC

Practice address

16313 New Independence Pkwy
Winter Garden, FL 34787-8113

Phone

(321) 221-6309

NPI assigned

Nov 23, 2022

Organization subpart

No

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

Authorized official

Name

Soujanya Pulluru

Title

Owner

Phone

(630) 545-4046

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": "1669161600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1669161600000",
    "number": "1437869963",
    "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": "16313 NEW INDEPENDENCE PKWY",
            "city": "WINTER GARDEN",
            "state": "FL",
            "postal_code": "347878113",
            "telephone_number": "321-221-6309"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MC MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-11-23",
        "last_updated": "2022-11-23",
        "certification_date": "2022-11-23",
        "status": "A",
        "authorized_official_last_name": "PULLURU",
        "authorized_official_first_name": "SOUJANYA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "630-545-4046"
    },
    "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"
        }
    ]
}

• Victor W Matthews, M.D.
• Maureen Sawh, OD, PLC
• Lovell Leonard Mayle, MD
• Mischelle Ann Mbonu
• Patricia MC Cormick, PT
• Taitlyn Elizabeth McCarthy-Miller
• Michael Douglas McCleary, M.D.
• Jalisa McCleskey
• Katie McClish
• Abigail Christine McClung

• General Practice Physician in Winter Garden, FL
• Providers in Winter Garden, 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 Nov 23, 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.