Provider Demographics
NPI:1619592136
Name:MAMMANA INTERGRATED PHYSICAL MEDICINE INC
Entity Type:Organization
Organization Name:MAMMANA INTERGRATED PHYSICAL MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MAMMANA
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:352-307-0033
Mailing Address - Street 1:15151 S US HIGHWAY 441 STE 200
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4482
Mailing Address - Country:US
Mailing Address - Phone:352-307-0033
Mailing Address - Fax:
Practice Address - Street 1:15151 S US HIGHWAY 441 STE 200
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-4482
Practice Address - Country:US
Practice Address - Phone:352-307-0033
Practice Address - Fax:352-307-1998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-10
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty