MEDICARE: MANNING FAMILY PRACTICE, LLC

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	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1992106009
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MANNING FAMILY PRACTICE, LLC

Provider Business Mailing Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 611
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1747
Country	:	US
Telephone Number	:	816-356-2020
Fax Number	:	816-356-2022

Provider Business Practice Location Address
First Line	:	4240 BLUE RIDGE BLVD
Second Line	:	SUITE 611
City	:	KANSAS CITY
State	:	MO
Zip	:	64133-1747
Country	:	US
Telephone Number	:	816-356-2020
Fax Number	:	816-356-2022

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DAVID L. BIERSMITH
Credential	:
Telephone Number	:	816-356-2020

Provider Enumeration Date	:	09/08/2014
Last Update Date	:	11/12/2014

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