Provider Demographics
NPI:1225182256
Name:MANN FAMILY CARE LTD
Entity Type:Organization
Organization Name:MANN FAMILY CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-596-0456
Mailing Address - Street 1:805 EAST PIKE STREET
Mailing Address - Street 2:
Mailing Address - City:JACKSON CENTER
Mailing Address - State:OH
Mailing Address - Zip Code:45334-0626
Mailing Address - Country:US
Mailing Address - Phone:937-596-0456
Mailing Address - Fax:937-596-0462
Practice Address - Street 1:805 EAST PIKE STREET
Practice Address - Street 2:
Practice Address - City:JACKSON CENTER
Practice Address - State:OH
Practice Address - Zip Code:45334-0626
Practice Address - Country:US
Practice Address - Phone:937-596-0456
Practice Address - Fax:937-596-0462
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35069861207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2020306Medicaid
OH0005170529OtherAETNA
OH000000233110OtherANTHEM
OHMA9325951Medicare ID - Type Unspecified
OH2020306Medicaid