Provider Demographics
NPI:1144593765
Name:MANTON HEALTH CENTER PLLC
Entity Type:Organization
Organization Name:MANTON HEALTH CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:MAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:231-645-1425
Mailing Address - Street 1:115 E 7TH ST
Mailing Address - Street 2:
Mailing Address - City:MANTON
Mailing Address - State:MI
Mailing Address - Zip Code:49663-9429
Mailing Address - Country:US
Mailing Address - Phone:231-824-4100
Mailing Address - Fax:231-824-4108
Practice Address - Street 1:829 TRADITIONS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49696-8965
Practice Address - Country:US
Practice Address - Phone:231-715-6113
Practice Address - Fax:231-824-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-13
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health