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General NPI Number Information
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NPI Number | 1538309471
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Entity Type | Organization
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Legal Business Name | MANCHIN CLINIC SOUTH
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Dates
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Enumeration Date | 03/05/2009
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Last Update Date | 03/05/2009
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Provider Practice Location Address
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Address Line | 181 MIDDLETOWN CIR
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City | FAIRMONT
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State | WV
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Zip | 26554-2015
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Country | US
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Telephone | 304-367-9170
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Fax | 304-367-9180
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Provider Business Mailing Address
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Address Line | 181 MIDDLETOWN CIR
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City | FAIRMONT
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State | WV
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Zip | 26554-2015
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Country | US
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Telephone | 304-367-9170
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Fax | 304-367-9180
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Authorized Official
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Title or Position | PARTNER
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Name | JOHN MANCHIN
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Credential | D.O.
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Telephone | 304-367-1970
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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