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General NPI Number Information
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NPI Number | 1710367933
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Entity Type | Organization
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Legal Business Name | MAC SERVICE NETWORK LLC
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Dates
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Enumeration Date | 06/03/2015
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 414 S 8TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-1025
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Country | US
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Telephone | 612-341-1601
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Fax | 612-341-1642
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Provider Business Mailing Address
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Address Line | 414 S 8TH ST
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City | MINNEAPOLIS
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State | MN
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Zip | 55404-1025
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Country | US
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Telephone | 612-341-1601
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Fax | 612-341-1642
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Authorized Official
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Title or Position | BILLING OFFICE MANAGER
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Name | ANGELA PETERSON
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Credential |
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Telephone | 612-341-1674
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251K00000X
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Taxonomy Name | Public Health or Welfare Agency
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License Number |
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License Number State | MN
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