Provider Demographics
NPI:1437150208
Name:MANNING, MARK E (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:MANNING
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:818 N EMPORIA ST
Mailing Address - Street 2:STE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67214-3729
Mailing Address - Country:US
Mailing Address - Phone:316-263-0296
Mailing Address - Fax:316-684-3326
Practice Address - Street 1:310 S HILLSIDE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67211-2129
Practice Address - Country:US
Practice Address - Phone:316-684-2838
Practice Address - Fax:316-684-3326
Is Sole Proprietor?:No
Enumeration Date:2005-08-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0429077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS042775OtherBLUE CROSS BLUE SHIELD
KS12127OtherPREFERRED PLUS OF KS
KS042775OtherWAL-MART
KS12127OtherPREFERRED HEALTH SYSTEMS
KS200801OtherHEALTH PARTNER OF KS
KS12127OtherPREFERRED HEALTH SYSTEMS
S84975Medicare UPIN