Basic Information
Provider Information | |||||||||
NPI: | 1730135815 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | MANINGAS | ||||||||
FirstName: | PETER | ||||||||
MiddleName: | ANTHONY | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 720 EMERALD POINT DR | ||||||||
Address2: | D2 | ||||||||
City: | HOLLISTER | ||||||||
State: | MO | ||||||||
PostalCode: | 656724839 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4172911129 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 620 N MAIN ST | ||||||||
Address2: |   | ||||||||
City: | HARRISON | ||||||||
State: | AR | ||||||||
PostalCode: | 726012911 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8704144000 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/26/2006 | ||||||||
LastUpdateDate: | 06/21/2010 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 114105 | MO | Y |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   | 207P00000X | E-5580 | AR | N |   | Allopathic & Osteopathic Physicians | Emergency Medicine |   |
ID Information
ID | Type | State | Issuer | Description | 175009001 | 05 | AR |   | MEDICAID | 243419306 | 05 | MO |   | MEDICAID | 204642102 | 05 | MO |   | MEDICAID |