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General NPI Number Information
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NPI Number | 1174692404
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Entity Type | Organization
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Legal Business Name | MCMJ, INC
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Dates
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Enumeration Date | 11/08/2006
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Last Update Date | 06/10/2009
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Provider Practice Location Address
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Address Line | 34 TANDY RD
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City | BROWNSVILLE
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State | TX
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Zip | 78520-9423
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Country | US
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Telephone | 956-350-2828
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Fax | 956-350-2829
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Provider Business Mailing Address
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Address Line | 34 TANDY RD
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City | BROWNSVILLE
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State | TX
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Zip | 78520-9423
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Country | US
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Telephone | 956-350-2828
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Fax | 956-350-2829
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Authorized Official
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Title or Position | OWNER
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Name | MR. EDWARD BUSTOS
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Credential |
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Telephone | 956-466-9402
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 1000011
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License Number State | TX
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