Provider Demographics
NPI:1871704429
Name:MC PREMIER CARE LLC
Entity type:Organization
Organization Name:MC PREMIER CARE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-270-3000
Mailing Address - Street 1:236 PARK PL
Mailing Address - Street 2:
Mailing Address - City:AZLE
Mailing Address - State:TX
Mailing Address - Zip Code:76020-3230
Mailing Address - Country:US
Mailing Address - Phone:817-270-3000
Mailing Address - Fax:817-270-3001
Practice Address - Street 1:236 PARK PL
Practice Address - Street 2:
Practice Address - City:AZLE
Practice Address - State:TX
Practice Address - Zip Code:76020-3230
Practice Address - Country:US
Practice Address - Phone:817-270-3000
Practice Address - Fax:817-270-3001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL2460207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX188075902Medicaid
TX00Y184Medicare PIN