Provider Demographics
NPI:1659367241
Name:MANNING FAMILY HEALTHCARE CLINIC PC
Entity Type:Organization
Organization Name:MANNING FAMILY HEALTHCARE CLINIC PC
Other - Org Name:P. L. MYER DO PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CLINIC ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:A
Authorized Official - Last Name:REINKE
Authorized Official - Suffix:
Authorized Official - Credentials:BS-HCM, CMA-C
Authorized Official - Phone:712-655-2551
Mailing Address - Street 1:321 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:MANNING
Mailing Address - State:IA
Mailing Address - Zip Code:51455-1020
Mailing Address - Country:US
Mailing Address - Phone:712-655-2551
Mailing Address - Fax:712-655-2579
Practice Address - Street 1:321 CENTER ST
Practice Address - Street 2:
Practice Address - City:MANNING
Practice Address - State:IA
Practice Address - Zip Code:51455-1020
Practice Address - Country:US
Practice Address - Phone:712-655-2551
Practice Address - Fax:712-655-2579
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-20
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0112920Medicaid
IA17370Medicare ID - Type Unspecified
IA0112920Medicaid