Provider Demographics
NPI:1518072370
Name:MANNING, JAMES GORDON III (CRNA)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:GORDON
Last Name:MANNING
Suffix:III
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:JIM
Other - Middle Name:G
Other - Last Name:MANNING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:CRNA
Mailing Address - Street 1:P.O. BOX 68
Mailing Address - Street 2:
Mailing Address - City:HAYS
Mailing Address - State:KS
Mailing Address - Zip Code:67601
Mailing Address - Country:US
Mailing Address - Phone:785-628-8113
Mailing Address - Fax:785-625-6126
Practice Address - Street 1:1904 E 29TH STREET
Practice Address - Street 2:
Practice Address - City:HAYS
Practice Address - State:KS
Practice Address - Zip Code:67601
Practice Address - Country:US
Practice Address - Phone:785-650-0600
Practice Address - Fax:785-650-0143
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS54114367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS146078OtherBCBS
KS058612Medicare PIN