MEDICARE: MCM HEALTHCARE GROUP LLC

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	363LF0000X	Family Nurse Practitioner

General Provider Information

NPI Number	:	1659108173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCM HEALTHCARE GROUP LLC

Provider Business Mailing Address
First Line	:	1389 W GULF BANK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-3652
Country	:	US
Telephone Number	:	281-356-0907
Fax Number	:

Provider Business Practice Location Address
First Line	:	1389 W GULF BANK RD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77088-3652
Country	:	US
Telephone Number	:	281-356-0907
Fax Number	:

Authorized Official
Title or Position	:	FNP
Name	:	ANISLEIDY COSTA MANZANO
Credential	:
Telephone Number	:	281-356-0907

Provider Enumeration Date	:	09/18/2024
Last Update Date	:	09/18/2024

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