# MACK OCCUPATIONAL HEALTH SERVICES SC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962645226
- **Authorized official:** MR. THOMAS V. MACK M.D. (CEO)
- **Authorized official phone:** (906) 424-4089

## Contact information

- **Practice address:** N528 FAIRLAND ISLAND, MENOMINEE, MI 49858
- **Practice address phone:** (906) 424-4089
- **Mailing address:** 2643 LIBAL STREET, GREEN BAY, WI 54301
- **Mailing address phone:** (920) 435-1604
- **Mailing address fax:** (920) 435-1670

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 04/15/2009
- **Last updated:** 06/03/2009