Provider Demographics
NPI:1447961248
Name:MK HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:MK HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MANFRED
Authorized Official - Middle Name:BISONG
Authorized Official - Last Name:ENOH
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:817-903-8467
Mailing Address - Street 1:112 GARDEN GROVE LN # TX75154
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:TX
Mailing Address - Zip Code:75154-0150
Mailing Address - Country:US
Mailing Address - Phone:817-903-8467
Mailing Address - Fax:469-552-6255
Practice Address - Street 1:112 GARDEN GROVE LN # TX75154
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:TX
Practice Address - Zip Code:75154-0150
Practice Address - Country:US
Practice Address - Phone:817-903-8467
Practice Address - Fax:469-552-6255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX26386910OtherDRIVER'S LICENSE
TX803707314OtherSOS
TX446173740Medicaid
TX803707314Medicaid
TX26386910OtherSOS