Provider Demographics
NPI:1790741643
Name:MCMJ INC.
Entity Type:Organization
Organization Name:MCMJ INC.
Other - Org Name:RELIABLE MEDICAL EQUIPMENT & SUPPLY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:BUSTOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-542-6400
Mailing Address - Street 1:2686 W ALTON GLOOR BLVD
Mailing Address - Street 2:SUIE 2
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78520-4054
Mailing Address - Country:US
Mailing Address - Phone:956-542-6400
Mailing Address - Fax:956-542-6401
Practice Address - Street 1:2686 W ALTON GLOOR BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78520-4054
Practice Address - Country:US
Practice Address - Phone:956-542-6400
Practice Address - Fax:956-542-6401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1000045332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX176568701Medicaid
TX176568701Medicaid