MEDICARE: MCR HEALTH, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician
3	332900000X	Non-Pharmacy Dispensing Site
4	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1346893328
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCR HEALTH, INC.

Provider Business Mailing Address
First Line	:	101 RIVERFRONT BLVD STE 710
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34205-8812
Country	:	US
Telephone Number	:	941-776-4000
Fax Number	:	941-845-4963

Provider Business Practice Location Address
First Line	:	5117 MADISON ST
Second Line	:
City	:	NEW PORT RICHEY
State	:	FL
Zip	:	34652-4312
Country	:	US
Telephone Number	:	941-776-4000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT & CEO
Name	:	MELVIN B PRICE
Credential	:
Telephone Number	:	941-776-4000

Provider Enumeration Date	:	07/19/2019
Last Update Date	:	06/12/2023

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