Provider Demographics
NPI:1609618628
Name:MAC MEDICAL & AESTHETICS CO.
Entity type:Organization
Organization Name:MAC MEDICAL & AESTHETICS CO.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:LESLIE
Authorized Official - Last Name:MCCLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:210-901-8197
Mailing Address - Street 1:PO BOX 311235
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-1235
Mailing Address - Country:US
Mailing Address - Phone:210-901-8197
Mailing Address - Fax:
Practice Address - Street 1:2146 FLINTSHIRE DR
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5066
Practice Address - Country:US
Practice Address - Phone:210-901-8197
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty