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General NPI Number Information
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NPI Number | 1144593765
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Entity Type | Organization
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Legal Business Name | MANTON HEALTH CENTER PLLC
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Dates
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Enumeration Date | 02/13/2012
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Last Update Date | 02/13/2012
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Provider Practice Location Address
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Address Line | 829 TRADITIONS DR
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City | TRAVERSE CITY
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State | MI
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Zip | 49696-8965
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Country | US
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Telephone | 231-715-6113
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Fax | 231-824-4108
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Provider Business Mailing Address
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Address Line | 115 E 7TH ST
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City | MANTON
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State | MI
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Zip | 49663-9429
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Country | US
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Telephone | 231-824-4100
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Fax | 231-824-4108
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Authorized Official
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Title or Position | MEMBER
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Name | DAVID B MAY
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Credential | D.O.
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Telephone | 231-645-1425
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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