MEDICARE: MCA MEDICAL, PLLC

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	2083P0011X	Undersea and Hyperbaric Medicine (Preventive Medicine) Physician

General Provider Information

NPI Number	:	1235776204
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCA MEDICAL, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 9080
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-0134
Country	:	US
Telephone Number	:	623-974-6611
Fax Number	:	623-974-9434

Provider Business Practice Location Address
First Line	:	14955 W BELL RD UNIT 9080
Second Line	:
City	:	SURPRISE
State	:	AZ
Zip	:	85374-8285
Country	:	US
Telephone Number	:	623-628-9349
Fax Number	:	623-691-8178

Authorized Official
Title or Position	:	CHIEF BILLER
Name	:	BERNADINE MOIRA SYKSTUS
Credential	:	MHA, CPCO, CPMA, RRT
Telephone Number	:	713-301-5707

Provider Enumeration Date	:	12/09/2019
Last Update Date	:	07/24/2024

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