Organization
MARACON HEALTH CARE SERVICES, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ONYEDIMMA NWACHUKU (CHIEF OF OPERATIONS)
(651) 641-0895
Entity
Organization
Contact information
Practice address
1595 SELBY AVENUE, SUITE 201, ST PAUL, MN 55104-6285
(651) 641-0895
(651) 641-0894
Mailing address
1595 SELBY AVENUE, SUITE 201, ST PAUL, MN 55104-6285
(651) 641-0895
(651) 641-0894
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
70G05MA
BLUE CROSS BLUE SHIELD
MN
Enumeration date
02/23/2006
Last updated
12/05/2007
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