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NPI Code Detail

MEDICARE: WILLIAM J. MANELY PAC

MEDICARE: WILLIAM J. MANELY PAC
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
1363A00000XPhysician Assistant464MT

General Provider Information

NPI Number : 1265449086
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM J. MANELY PAC
Provider Business Mailing Address
First Line : PO BOX 644
Second Line :
City : FORT DODGE
State : IA
Zip : 50501-0644
Country : US
Telephone Number : 319-369-8153
Fax Number :
Provider Business Practice Location Address
First Line : 830 1ST AVE NE
Second Line :
City : CEDAR RAPIDS
State : IA
Zip : 52402-5004
Country : US
Telephone Number : 319-369-8153
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/02/2006
Last Update Date : 05/13/2010

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