MP TOTALCARE MEDICAL, INC.

Provider Demographics

• NPI: 1841382363
• Name: MP TOTALCARE MEDICAL, INC.
• Entity type: Organization
• Organization Name: MP TOTALCARE MEDICAL, INC.
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: DIRECTOR/SECRETARY
• Authorized Official - Prefix: MS
• Authorized Official - First Name: MONICA
• Authorized Official - Middle Name: S
• Authorized Official - Last Name: RAINES
• Authorized Official - Phone: 972-628-2100
• Mailing Address - Street 1: 1505 LBJ FREEWAY
• Mailing Address - Street 2: SUITE 600
• Mailing Address - City: FARMERS BRANCH
• Mailing Address - State: TX
• Mailing Address - Zip Code: 75234-6074
• Mailing Address - Country: US
• Mailing Address - Phone: 972-628-2100
• Practice Address - Street 1: 3505 KOGER BLVD.
• Practice Address - Street 2: SUITE 220
• Practice Address - City: DULUTH
• Practice Address - State: GA
• Practice Address - Zip Code: 30096-7671
• Practice Address - Country: US
• Practice Address - Phone: 770-407-4430
• Practice Address - Fax: 866-387-8451
• EIN: <UNAVAIL>
• Is Organization Subpart?: Yes
• Parent Organization LBN: CCS MEDICAL HOLDINGS, INC.
• Parent Organization TIN: <UNAVAIL>
• Enumeration Date: 2006-09-29
• Last Update Date: 2014-08-04

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization
Yes	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies

Provider Identifiers

State	Identifier ID	ID Type	Issuer
AL	009305140	Medicaid
WY	111086100	Medicaid
LA	1970557	Medicaid
FL	9502459-00	Medicaid
SC	DME593	Medicaid
OK	100798850A	Medicaid
OR	207944	Medicaid
MN	795517100	Medicaid
NJ	8106908	Medicaid
TX	0761892-02 CSHCN	Medicaid
OH	0962196	Medicaid
KS	100005220A	Medicaid
NH	30008023	Medicaid
MD	332558000	Medicaid
RI	3870001	Medicaid
PA	0014731660004	Medicaid
TX	141828701	Medicaid
ME	180770000	Medicaid
MT	1841382363	Medicaid
AZ	866585	Medicaid
MI	87-4442397	Medicaid
NM	00076382	Medicaid
MS	00440047	Medicaid
VA	0091-2871-9	Medicaid
DC	032738900	Medicaid
KY	1125513	Medicaid
TN	4581554	Medicaid
ND	59910	Medicaid
WI	81444000	Medicaid
WV	9100026000	Medicaid
CO	98003254	Medicaid
ID	002105800	Medicaid
IA	0955997	Medicaid
KY	90022302	Medicaid
WA	9039470	Medicaid
GA	00405226B	Medicaid
NY	02871598	Medicaid
AR	125809741	Medicaid
TX	141797401	Medicaid
MA	1536303	Medicaid
SD	9160610	Medicaid
IN	100381070B	Medicaid
AK	MS392CA	Medicaid
ND	59910	Medicaid
KY	90022302	Medicaid
WV	9100026000	Medicaid
IL	=========002	Medicaid