MEDICARE: NORTH TEXAS - MCA 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	261QE0002X	Emergency Care Clinic/Center

General Provider Information

NPI Number	:	1821934647
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH TEXAS - MCA LLC

Provider Business Mailing Address
First Line	:	13172 HIGHWAY 287
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-2619
Country	:	US
Telephone Number	:	817-639-2830
Fax Number	:

Provider Business Practice Location Address
First Line	:	13172 HIGHWAY 287
Second Line	:
City	:	HASLET
State	:	TX
Zip	:	76052-2619
Country	:	US
Telephone Number	:	817-639-2830
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	GLENN R. WALLACE
Credential	:
Telephone Number	:	817-639-1102

Provider Enumeration Date	:	04/24/2026
Last Update Date	:	04/24/2026

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Directions to “NORTH TEXAS - MCA LLC ” Practice Location

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