Provider Demographics
NPI:1194158030
Name:SCAMARDO MHT LLC
Entity type:Organization
Organization Name:SCAMARDO MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LUKE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SCAMARDO
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:936-825-6444
Mailing Address - Street 1:1515 HERITAGE DRIVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3379
Mailing Address - Country:US
Mailing Address - Phone:855-860-2109
Mailing Address - Fax:855-814-8428
Practice Address - Street 1:501 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:NAVASOTA
Practice Address - State:TX
Practice Address - Zip Code:77868-3001
Practice Address - Country:US
Practice Address - Phone:855-860-2109
Practice Address - Fax:855-814-8428
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE7502207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty