Provider Demographics
NPI:1851729594
Name:MACC ENTERPRISES LLC
Entity Type:Organization
Organization Name:MACC ENTERPRISES LLC
Other - Org Name:ACTIVERX - PLANO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-402-3882
Mailing Address - Street 1:3820 AMERICAN DR
Mailing Address - Street 2:SUITE 170
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-6126
Mailing Address - Country:US
Mailing Address - Phone:972-985-6006
Mailing Address - Fax:972-985-6001
Practice Address - Street 1:3820 AMERICAN DR
Practice Address - Street 2:SUITE 170
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-6126
Practice Address - Country:US
Practice Address - Phone:972-985-6006
Practice Address - Fax:972-685-6001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty