1528000189 NPI number — MICHAEL W MANN MD PA

Table of content: (NPI 1528000189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528000189 NPI number — MICHAEL W MANN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MICHAEL W MANN MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CENTURY REGIONAL HEALTH CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1528000189
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
32665 US HIGHWAY 281 N
Provider Second Line Business Mailing Address:
P.O. BOX 412
Provider Business Mailing Address City Name:
BULVERDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78163-3124
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-980-9686
Provider Business Mailing Address Fax Number:
830-438-3423

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32665 US HIGHWAY 281 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BULVERDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78163-3124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-980-9686
Provider Business Practice Location Address Fax Number:
830-438-3423
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MANN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
WILLIAM
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
830-980-9686

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2083P0500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AS0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 100188503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100188504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG1029 . This is a "PALMETTO GBA RAILROAD MED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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