Provider Demographics
NPI:1689650582
Name:SUSAN W MANCHESTER
Entity Type:Organization
Organization Name:SUSAN W MANCHESTER
Other - Org Name:MANCHESTER MEDICAL BILLING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MANCHESTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-777-5002
Mailing Address - Street 1:7762 PIKES PEAK DR
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32244-6439
Mailing Address - Country:US
Mailing Address - Phone:904-777-5002
Mailing Address - Fax:904-779-7184
Practice Address - Street 1:7762 PIKES PEAK DR
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32244-6439
Practice Address - Country:US
Practice Address - Phone:904-777-5002
Practice Address - Fax:904-779-7184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2008-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health InformationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL991314900Medicaid