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NPI Code Detail

MEDICARE: DR. ANDREW PHILIP MANISTA MD

MEDICARE: DR. ANDREW PHILIP MANISTA MD
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
1207X00000XOrthopaedic Surgery PhysicianP17178MD
2207X00000XOrthopaedic Surgery PhysicianMD60023058WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MD60023058OTHERWAWASHINGTON STATE

General Provider Information

NPI Number : 1316084056
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDREW PHILIP MANISTA MD
Provider Business Mailing Address
First Line : PO BOX 368
Second Line :
City : OLYMPIA
State : WA
Zip : 98507-0368
Country : US
Telephone Number : 360-491-8439
Fax Number : 360-491-6328
Provider Business Practice Location Address
First Line : 404 YAUGER WAY SW
Second Line : SUITE 100
City : OLYMPIA
State : WA
Zip : 98502-8660
Country : US
Telephone Number : 360-786-8990
Fax Number : 360-786-9010
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2007
Last Update Date : 10/02/2008

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