MEDICARE: MAC CONSULTING, 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	251X00000X	Supports Brokerage Agency	425094	MO

General Provider Information

NPI Number	:	1457788309
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MAC CONSULTING, INC

Provider Business Mailing Address
First Line	:	3 LAKE FOREST DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1304
Country	:	US
Telephone Number	:	314-437-1906
Fax Number	:	314-256-1469

Provider Business Practice Location Address
First Line	:	3 LAKE FOREST DR
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63117-1304
Country	:	US
Telephone Number	:	314-437-1906
Fax Number	:	314-256-1469

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	MR. ANTHONY COLEMAN
Credential	:
Telephone Number	:	31344371906

Provider Enumeration Date	:	10/07/2013
Last Update Date	:	10/07/2013

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