=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831129196
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MCMJ MEDICAL MANAGEMENT SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/03/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 NORTH RAUL LONGORIA RD STE I2
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-782-5555
-----------------------------------------------------
Fax | 956-782-5556
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1205 NORTH RAUL LONGORIA RD STE I2
-----------------------------------------------------
City | SAN JUAN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78589
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 956-782-5555
-----------------------------------------------------
Fax | 956-782-5556
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF FINANCIAL OFFICER
-----------------------------------------------------
Name | MR. MARCO ANTONIO TURRUBIATES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 956-535-2092
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------