Provider Demographics
NPI:1770754293
Name:THAD R MANNING D.O., PSC
Entity type:Organization
Organization Name:THAD R MANNING D.O., PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:THAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:MANNING
Authorized Official - Suffix:
Authorized Official - Credentials:DO,
Authorized Official - Phone:606-754-7089
Mailing Address - Street 1:9613 MILLARD HWY
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41501-8162
Mailing Address - Country:US
Mailing Address - Phone:606-754-7089
Mailing Address - Fax:
Practice Address - Street 1:9613 MILLARD HWY
Practice Address - Street 2:
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-8162
Practice Address - Country:US
Practice Address - Phone:606-754-7089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2014-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9298Medicare PIN