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General NPI Number Information
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NPI Number | 1679620603
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Entity Type | Organization
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Legal Business Name | MANUEL MEDICAL CLINIC, INC.
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Dates
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Enumeration Date | 01/04/2007
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Last Update Date | 04/21/2020
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Provider Practice Location Address
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Address Line | 104 GENEVIEVE DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-4811
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Country | US
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Telephone | 337-984-0110
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Fax | 337-981-7210
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Provider Business Mailing Address
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Address Line | 104 GENEVIEVE DR
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City | LAFAYETTE
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State | LA
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Zip | 70503-4811
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Country | US
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Telephone | 337-984-0110
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Fax | 337-981-7210
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. POWLIN V MANUEL
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Credential | MD
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Telephone | 337-984-0110
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP05389
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP07960
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License Number State | LA
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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