Basic Information
| Provider Information | |||||||||
| NPI: | 1457593618 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMANUS | ||||||||
| FirstName: | FALLON | ||||||||
| MiddleName: | STROTHER | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 103 CENTRE SARCELLE BLVD | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898978 | ||||||||
| FaxNumber: | 3372898977 | ||||||||
| Practice Location | |||||||||
| Address1: | 103 CENTRE SARCELLE BLVD | ||||||||
| Address2: | SUITE 506 | ||||||||
| City: | YOUNGSVILLE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3372898978 | ||||||||
| FaxNumber: | 3372898977 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/01/2009 | ||||||||
| LastUpdateDate: | 10/21/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 204192 | LA | Y | Allopathic & Osteopathic Physicians | Family Medicine | 390200000X | N | Student, Health Care | Student in an Organized Health Care Education/Training Program |
ID Information
| ID | Type | State | Issuer | Description | 1989673 | 05 | LA | MEDICAID |