Provider Demographics
NPI:1427052059
Name:MC MEDICAL INC
Entity type:Organization
Organization Name:MC MEDICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO / PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:MILDRED
Authorized Official - Middle Name:COLLAZO
Authorized Official - Last Name:HERNANDEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:787-841-6355
Mailing Address - Street 1:PO BOX 328
Mailing Address - Street 2:
Mailing Address - City:MERCEDITA
Mailing Address - State:PR
Mailing Address - Zip Code:00715-0328
Mailing Address - Country:US
Mailing Address - Phone:787-841-6355
Mailing Address - Fax:787-844-0309
Practice Address - Street 1:1266 AVE HOSTOS
Practice Address - Street 2:SUITE 102
Practice Address - City:PONCE
Practice Address - State:PR
Practice Address - Zip Code:00717-0947
Practice Address - Country:US
Practice Address - Phone:787-841-6355
Practice Address - Fax:787-844-0309
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-10
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
227900000X
PRMC0100C332B00000X, 332BP3500X, 332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No227900000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredGroup - Multi-Specialty
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral NutritionGroup - Multi-Specialty
No332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0418570001Medicare ID - Type Unspecified