Basic Information
| Provider Information | |||||||||
| NPI: | 1144593765 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MANTON HEALTH CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 E 7TH ST | ||||||||
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| City: | MANTON | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496639429 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2318244100 | ||||||||
| FaxNumber: | 2318244108 | ||||||||
| Practice Location | |||||||||
| Address1: | 829 TRADITIONS DR | ||||||||
| Address2: | |||||||||
| City: | TRAVERSE CITY | ||||||||
| State: | MI | ||||||||
| PostalCode: | 496968965 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2317156113 | ||||||||
| FaxNumber: | 2318244108 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/13/2012 | ||||||||
| LastUpdateDate: | 02/13/2012 | ||||||||
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| AuthorizedOfficialLastName: | MAY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | MEMBER | ||||||||
| AuthorizedOfficialTelephone: | 2316451425 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QR1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Rural Health |
No ID Information.