Provider Demographics
NPI:1023178555
Name:MANOR MEDICAL SUPPLY INC.
Entity Type:Organization
Organization Name:MANOR MEDICAL SUPPLY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:K
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:715-762-2449
Mailing Address - Street 1:509 BIRCH ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:PARK FALLS
Mailing Address - State:WI
Mailing Address - Zip Code:54552-1416
Mailing Address - Country:US
Mailing Address - Phone:715-762-2449
Mailing Address - Fax:715-762-4982
Practice Address - Street 1:509 BIRCH ST
Practice Address - Street 2:SUITE B
Practice Address - City:PARK FALLS
Practice Address - State:WI
Practice Address - Zip Code:54552-1416
Practice Address - Country:US
Practice Address - Phone:715-762-2449
Practice Address - Fax:715-762-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI41676400Medicaid
WI0623180001Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER