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	227900000X	Registered Respiratory Therapist
2	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)	MC0100C	PR
3	332BX2000X	Oxygen Equipment & Supplies (DME)	MC0100C	PR
4	332B00000X	Durable Medical Equipment & Medical Supplies	MC0100C	PR

General Provider Information

NPI Number	:	1427052059
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MC MEDICAL INC

Provider Business Mailing Address
First Line	:	PO BOX 328
Second Line	:
City	:	MERCEDITA
State	:	PR
Zip	:	00715-0328
Country	:	US
Telephone Number	:	787-841-6355
Fax Number	:	787-844-0309

Provider Business Practice Location Address
First Line	:	1266 AVE HOSTOS
Second Line	:	SUITE 102
City	:	PONCE
State	:	PR
Zip	:	00717-0947
Country	:	US
Telephone Number	:	787-841-6355
Fax Number	:	787-844-0309

Authorized Official
Title or Position	:	CEO / PRESIDENT
Name	:	MRS. MILDRED COLLAZO HERNANDEZ
Credential	:	RN
Telephone Number	:	787-841-6355

Provider Enumeration Date	:	06/10/2005
Last Update Date	:	09/22/2010

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Directions to “MC MEDICAL INC ” Practice Location

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