MEDICARE: BRUCE MHT LLC

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	207Q00000X	Family Medicine Physician	H6081	TX

General Provider Information

NPI Number	:	1316348469
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BRUCE MHT LLC

Provider Business Mailing Address
First Line	:	1515 HERITAGE DRIVE
Second Line	:	SUITE 110
City	:	MCKINNEY
State	:	TX
Zip	:	75069-3379
Country	:	US
Telephone Number	:	855-860-2109
Fax Number	:

Provider Business Practice Location Address
First Line	:	12422 HIGHWAY 6
Second Line	:
City	:	SANTA FE
State	:	TX
Zip	:	77510-7608
Country	:	US
Telephone Number	:	409-316-9298
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRESIDENT
Name	:	LENA BRUCE
Credential	:	MD
Telephone Number	:	409-739-9320

Provider Enumeration Date	:	09/09/2014
Last Update Date	:	01/02/2015

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