Healthcare Provider Details

I. General information

NPI: 1447815923
Provider Name (Legal Business Name): MCDXTX, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2019
Last Update Date: 05/09/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

905 S JACKSON RD
PHARR TX
78577-6616
US

IV. Provider business mailing address

8719 BELIZE DR
LAREDO TX
78045-8000
US

V. Phone/Fax

Practice location:
  • Phone: 956-638-2808
  • Fax:
Mailing address:
  • Phone: 956-638-2808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code311500000X
TaxonomyAlzheimer Center (Dementia Center)
License Number
License Number State

VIII. Authorized Official

Name: MRS. CARLOS RAMIREZ
Title or Position: MEMBER/MANAGER
Credential:
Phone: 956-638-2808