=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871704429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MC PREMIER CARE LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/25/2007
-----------------------------------------------------
Last Update Date | 12/15/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 236 PARK PL
-----------------------------------------------------
City | AZLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76020-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-270-3000
-----------------------------------------------------
Fax | 817-270-3001
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 236 PARK PL
-----------------------------------------------------
City | AZLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76020-3230
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-270-3000
-----------------------------------------------------
Fax | 817-270-3001
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. MICHAEL KENT MCFARLAND
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 817-270-3000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | L2460
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------