Provider Demographics
NPI:1922551852
Name:MANTON MEDICAL EQUIPMENT, LLC
Entity Type:Organization
Organization Name:MANTON MEDICAL EQUIPMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JORDAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHEPLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:231-920-1621
Mailing Address - Street 1:2033 W MOORESTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49651-9343
Mailing Address - Country:US
Mailing Address - Phone:231-920-1621
Mailing Address - Fax:
Practice Address - Street 1:113 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MANTON
Practice Address - State:MI
Practice Address - Zip Code:49663-9152
Practice Address - Country:US
Practice Address - Phone:231-920-1621
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-27
Last Update Date:2016-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization