MEDICARE: DR. PETER ANTHONY MANINGAS 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
1	207P00000X	Emergency Medicine Physician	114105	MO
2	207P00000X	Emergency Medicine Physician	E-5580	AR

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730135815
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PETER ANTHONY MANINGAS MD

Provider Business Mailing Address
First Line	:	720 EMERALD POINT DR
Second Line	:	D2
City	:	HOLLISTER
State	:	MO
Zip	:	65672-4839
Country	:	US
Telephone Number	:	417-291-1129
Fax Number	:

Provider Business Practice Location Address
First Line	:	620 N MAIN ST
Second Line	:
City	:	HARRISON
State	:	AR
Zip	:	72601-2911
Country	:	US
Telephone Number	:	870-414-4000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/26/2006
Last Update Date	:	06/21/2010

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