Organization
MARACON HEALTH CARE SERVICES, INC
Active
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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