Provider Demographics
NPI:1710367933
Name:MAC SERVICE NETWORK LLC
Entity Type:Organization
Organization Name:MAC SERVICE NETWORK LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:612-341-1674
Mailing Address - Street 1:414 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55404-1025
Mailing Address - Country:US
Mailing Address - Phone:612-341-1601
Mailing Address - Fax:612-341-1642
Practice Address - Street 1:414 S 8TH ST
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55404-1025
Practice Address - Country:US
Practice Address - Phone:612-341-1601
Practice Address - Fax:612-341-1642
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare