MEDICARE: MANOR MEDICAL SUPPLY INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1023178555
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANOR MEDICAL SUPPLY INC.

Provider Business Mailing Address
First Line	:	509 BIRCH ST
Second Line	:	SUITE B
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1416
Country	:	US
Telephone Number	:	715-762-2449
Fax Number	:	715-762-4982

Provider Business Practice Location Address
First Line	:	509 BIRCH ST
Second Line	:	SUITE B
City	:	PARK FALLS
State	:	WI
Zip	:	54552-1416
Country	:	US
Telephone Number	:	715-762-2449
Fax Number	:	715-762-4982

Authorized Official
Title or Position	:	SECRETARY TREASURER
Name	:	SHARON K SCHULTZ
Credential	:
Telephone Number	:	715-762-2449

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	08/22/2020

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