MEDICARE: MC MEDICAL, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)	02767/11.1	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104821719
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MC MEDICAL, INC.

Provider Business Mailing Address
First Line	:	PO BOX 1189
Second Line	:
City	:	MONTICELLO
State	:	MS
Zip	:	39654-1189
Country	:	US
Telephone Number	:	601-587-0173
Fax Number	:	601-587-0280

Provider Business Practice Location Address
First Line	:	1223 HIGHWAY 98 BYP
Second Line	:
City	:	COLUMBIA
State	:	MS
Zip	:	39429-3732
Country	:	US
Telephone Number	:	601-736-7994
Fax Number	:	601-731-7691

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	MARILYN MULLINS
Credential	:
Telephone Number	:	601-587-0173

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	10/09/2014

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