| Entity Name: | MCW PSYCH CARE MD, LLC |
| Jurisdiction: | FLORIDA |
| Filing Type: | Florida Limited Liability Co. |
| Status: | Active |
| Date Filed: | 15 Oct 2021 (3 years ago) |
| Document Number: | L21000450650 |
| FEI/EIN Number | 87-3087549 |
| Address: | 4512 NW 74TH TERRACE, OCALA, FL, 34482, US |
| Mail Address: | 4512 NW 74TH TERRACE, OCALA, FL, 34482, US |
| ZIP code: | 34482 |
| County: | Marion |
| Place of Formation: | FLORIDA |
| NPI | Enumeration Date | Last Update Date | Mailing Address | Practice Location Address | |||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 1699438549 | 2021-10-18 | 2021-10-22 | 4512 NW 74TH TER, OCALA, FL, 344826759, US | 4512 NW 74TH TER, OCALA, FL, 344826759, US | |||||||||||||||||||||
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| Phone | +1 352-497-5920 |
| Fax | 9853171862 |
Authorized person
| Name | DR. MARK CHRISTOPHER WALKER |
| Role | CEO/PRESIDENT |
| Phone | 3524975920 |
Taxonomy
| Taxonomy Code | 2084P0800X - Psychiatry Physician |
| Is Primary | Yes |
Other Provider Identifiers
| Issuer | MEDICAID |
| Number | 100556600 |
| State | FL |
| Name | Role | Address |
|---|---|---|
| WALKER MARK CMD | Agent | 4512 NW 74TH TERRACE, OCALA, FL, 34482 |
| Name | Role | Address |
|---|---|---|
| WALKER MARK CMD | Manager | 4512 NW 74TH TERRACE, OCALA, FL, 34482 |
| Name | Date |
|---|---|
| ANNUAL REPORT | 2024-02-05 |
| ANNUAL REPORT | 2023-02-19 |
| ANNUAL REPORT | 2022-03-02 |
| Florida Limited Liability | 2021-10-15 |
Date of last update: 01 Feb 2025
Sources: Florida Department of State
