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NPI Code Detail

MEDICARE: MANNING BLAIR MA

MEDICARE: MANNING BLAIR MA
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
1101Y00000XCounselor

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1510-95176OTHERALBCBS OF AL

General Provider Information

NPI Number : 1841256583
Entity Type Code : Individual
Provider Name (Legal Business Name) : MANNING BLAIR MA
Provider Business Mailing Address
First Line : 635 W COLLEGE ST
Second Line :
City : FLORENCE
State : AL
Zip : 35630-5313
Country : US
Telephone Number : 256-764-3431
Fax Number : 256-765-2036
Provider Business Practice Location Address
First Line : 635 W COLLEGE ST
Second Line :
City : FLORENCE
State : AL
Zip : 35630-5313
Country : US
Telephone Number : 256-764-3431
Fax Number : 256-765-2036
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/21/2006
Last Update Date : 07/08/2007

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Directions to “ MANNING BLAIR MA” Practice Location

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