Healthcare Provider Details

I. General information

NPI: 1790613172
Provider Name (Legal Business Name): MANITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2729 N HAVEN DR
EAGLE ID
83616-2331
US

IV. Provider business mailing address

2729 N HAVEN DR
EAGLE ID
83616-2331
US

V. Phone/Fax

Practice location:
  • Phone: 636-544-7491
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State

VIII. Authorized Official

Name: PETER SCHOCH
Title or Position: OWNER
Credential: MD
Phone: 636-544-7491