Basic Information
| Provider Information | |||||||||
| NPI: | 1710367933 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MAC SERVICE NETWORK LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 414 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554041025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123411601 | ||||||||
| FaxNumber: | 6123411642 | ||||||||
| Practice Location | |||||||||
| Address1: | 414 S 8TH ST | ||||||||
| Address2: | |||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554041025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6123411601 | ||||||||
| FaxNumber: | 6123411642 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/03/2015 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | PETERSON | ||||||||
| AuthorizedOfficialFirstName: | ANGELA | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6123411674 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251K00000X | MN | Y | Agencies | Public Health or Welfare |
No ID Information.