MEDICARE: MCR HEALTH, INC.

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	261QF0400X	Federally Qualified Health Center (FQHC)
2	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598158446
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	:	300 RIVERSIDE DR E STE 2010
Second Line	:
City	:	BRADENTON
State	:	FL
Zip	:	34208-1023
Country	:	US
Telephone Number	:	941-405-1170
Fax Number	:	941-405-1175

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

Provider Enumeration Date	:	03/16/2015
Last Update Date	:	11/27/2023

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