MEDICARE: MAC-CON PROPERTIES 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	302R00000X	Health Maintenance Organization	1045322-1-AFC	MN

General Provider Information

NPI Number	:	1396863304
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAC-CON PROPERTIES INC.

Provider Business Mailing Address
First Line	:	1022 POPLAR DR
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-3091
Country	:	US
Telephone Number	:	218-825-0071
Fax Number	:

Provider Business Practice Location Address
First Line	:	1022 POPLAR DR
Second Line	:
City	:	EAST GULL LAKE
State	:	MN
Zip	:	56401-3091
Country	:	US
Telephone Number	:	218-825-0071
Fax Number	:

Authorized Official
Title or Position	:	PROGRAM DIRECTOR
Name	:	MRS. JACLYN ANNE LANGNER
Credential	:
Telephone Number	:	320-360-3815

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	08/13/2008

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