Provider Demographics
NPI:1457754749
Name:MANUELE & ASSOCIATES OBSTETRICS & GYNECOLOGY PLLC
Entity Type:Organization
Organization Name:MANUELE & ASSOCIATES OBSTETRICS & GYNECOLOGY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELAINA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MANUELE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:662-417-5475
Mailing Address - Street 1:PO BOX 187
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-0187
Mailing Address - Country:US
Mailing Address - Phone:931-766-1800
Mailing Address - Fax:844-269-7724
Practice Address - Street 1:237 E TAYLOR ST
Practice Address - Street 2:SUITE A
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464-3723
Practice Address - Country:US
Practice Address - Phone:931-766-1800
Practice Address - Fax:844-269-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-01
Last Update Date:2014-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN35420207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3866766Medicaid
G98769Medicare UPIN
103I165440Medicare PIN