Basic Information
| Provider Information | |||||||||
| NPI: | 1194995126 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | RONAL D MANIS JR MD INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | INTREPID CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1752 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | PIQUA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453569325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377733737 | ||||||||
| FaxNumber: | 9374404250 | ||||||||
| Practice Location | |||||||||
| Address1: | 1752 W HIGH ST | ||||||||
| Address2: | |||||||||
| City: | PIQUA | ||||||||
| State: | OH | ||||||||
| PostalCode: | 453569325 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9377733737 | ||||||||
| FaxNumber: | 9374404250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/05/2008 | ||||||||
| LastUpdateDate: | 01/27/2011 | ||||||||
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| AuthorizedOfficialLastName: | HUFF | ||||||||
| AuthorizedOfficialFirstName: | NICOLA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9377733737 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RI0200X | 35043967 | OH | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 0837527 | 05 | OH | MEDICAID |