Provider Demographics
NPI:1639421126
Name:MANAGED CARE OUTSOURCE, INC
Entity Type:Organization
Organization Name:MANAGED CARE OUTSOURCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:D
Authorized Official - Last Name:STACK
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN MN
Authorized Official - Phone:404-633-0545
Mailing Address - Street 1:2793 CLAIRMONT RD NE
Mailing Address - Street 2:SUITE 213
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-2700
Mailing Address - Country:US
Mailing Address - Phone:404-633-0545
Mailing Address - Fax:404-781-0779
Practice Address - Street 1:2793 CLAIRMONT RD NE
Practice Address - Street 2:SUITE 213
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30329-2700
Practice Address - Country:US
Practice Address - Phone:404-633-0545
Practice Address - Fax:404-781-0779
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-08
Last Update Date:2012-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1800XAmbulatory Health Care FacilitiesClinic/CenterCorporate Health