Provider Demographics
NPI:1316369556
Name:MANTE PEDIATRICS OF ROCK HILL INC.
Entity Type:Organization
Organization Name:MANTE PEDIATRICS OF ROCK HILL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATIENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MANTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:803-313-3846
Mailing Address - Street 1:1626 CRANIUM DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:ROCK HILL
Mailing Address - State:SC
Mailing Address - Zip Code:29732-3506
Mailing Address - Country:US
Mailing Address - Phone:803-980-5700
Mailing Address - Fax:803-980-5702
Practice Address - Street 1:1626 CRANIUM DR
Practice Address - Street 2:SUITE 103
Practice Address - City:ROCK HILL
Practice Address - State:SC
Practice Address - Zip Code:29732-3506
Practice Address - Country:US
Practice Address - Phone:803-980-5700
Practice Address - Fax:803-980-5702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-07
Last Update Date:2014-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC29696261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC296968Medicaid