Provider Demographics
NPI:1629363882
Name:REX MANN MD PA
Entity Type:Organization
Organization Name:REX MANN MD PA
Other - Org Name:FAMILY HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:L
Authorized Official - Last Name:MANN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:806-435-7154
Mailing Address - Street 1:3019 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-5357
Mailing Address - Country:US
Mailing Address - Phone:806-435-7154
Mailing Address - Fax:806-435-6909
Practice Address - Street 1:3019 S MAIN ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-5357
Practice Address - Country:US
Practice Address - Phone:806-435-7154
Practice Address - Fax:806-435-6909
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:REX MANN MD PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-06-16
Last Update Date:2012-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG3581208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXC18748Medicare UPIN