Provider Demographics
NPI:1528000189
Name:MICHAEL W MANN MD PA
Entity Type:Organization
Organization Name:MICHAEL W MANN MD PA
Other - Org Name:CENTURY REGIONAL HEALTH CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-980-9686
Mailing Address - Street 1:32665 US HIGHWAY 281 N
Mailing Address - Street 2:P.O. BOX 412
Mailing Address - City:BULVERDE
Mailing Address - State:TX
Mailing Address - Zip Code:78163-3124
Mailing Address - Country:US
Mailing Address - Phone:830-980-9686
Mailing Address - Fax:830-438-3423
Practice Address - Street 1:32665 US HIGHWAY 281 N
Practice Address - Street 2:
Practice Address - City:BULVERDE
Practice Address - State:TX
Practice Address - Zip Code:78163-3124
Practice Address - Country:US
Practice Address - Phone:830-980-9686
Practice Address - Fax:830-438-3423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
No2083P0500XAllopathic & Osteopathic PhysiciansPreventive MedicinePreventive Medicine/Occupational Environmental MedicineGroup - Single Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX100188503Medicaid
TX100188504Medicaid
TXDG1029OtherPALMETTO GBA RAILROAD MED
TX100188503Medicaid
TXDG1029OtherPALMETTO GBA RAILROAD MED