MEDICARE: SIMAC PROFESSIONAL BUSINESS SERVICES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency	342169	MN

General Provider Information

NPI Number	:	1851545834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SIMAC PROFESSIONAL BUSINESS SERVICES, INC.

Provider Business Mailing Address
First Line	:	6000 BASS LAKE RD
Second Line	:	SUITE #213
City	:	CRYSTAL
State	:	MN
Zip	:	55429-2700
Country	:	US
Telephone Number	:	763-432-3328
Fax Number	:

Provider Business Practice Location Address
First Line	:	6000 BASS LAKE RD
Second Line	:	SUITE # 213
City	:	CRYSTAL
State	:	MN
Zip	:	55429-2700
Country	:	US
Telephone Number	:	763-432-3328
Fax Number	:

Authorized Official
Title or Position	:	ADMINSTRATOR
Name	:	SIMONE MACDOLD ACOLATSE
Credential	:
Telephone Number	:	763-432-3328

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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