Provider Demographics
NPI:1538309471
Name:MANCHIN CLINIC SOUTH
Entity Type:Organization
Organization Name:MANCHIN CLINIC SOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-367-1970
Mailing Address - Street 1:181 MIDDLETOWN CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26554-2015
Mailing Address - Country:US
Mailing Address - Phone:304-367-9170
Mailing Address - Fax:304-367-9180
Practice Address - Street 1:181 MIDDLETOWN CIR
Practice Address - Street 2:
Practice Address - City:FAIRMONT
Practice Address - State:WV
Practice Address - Zip Code:26554-2015
Practice Address - Country:US
Practice Address - Phone:304-367-9170
Practice Address - Fax:304-367-9180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-05
Last Update Date:2009-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center