Provider Demographics
NPI:1053499673
Name:MANNING, THAD (DO)
Entity Type:Individual
Prefix:
First Name:THAD
Middle Name:
Last Name:MANNING
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9613 MILLARD HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-0195
Mailing Address - Country:US
Mailing Address - Phone:606-754-4707
Mailing Address - Fax:606-754-9218
Practice Address - Street 1:169 BURT RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-2455
Practice Address - Country:US
Practice Address - Phone:859-278-9242
Practice Address - Fax:859-278-0322
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2014-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY02807207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069271Medicaid
KYH74708Medicare UPIN
KY0929801Medicare PIN