Provider Demographics
NPI:1568707685
Name:MCS MEDICAL COSMETIC SOURCE, INC
Entity Type:Organization
Organization Name:MCS MEDICAL COSMETIC SOURCE, INC
Other - Org Name:SKIN ESSENTIALS MED SPA & HAIR SALON
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-487-2828
Mailing Address - Street 1:6429 FAIRMONT PKWY
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77505-4220
Mailing Address - Country:US
Mailing Address - Phone:821-487-2828
Mailing Address - Fax:
Practice Address - Street 1:6429 FAIRMONT PKWY
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77505-4220
Practice Address - Country:US
Practice Address - Phone:821-487-2828
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty