Provider Demographics
NPI:1194995126
Name:RONAL D MANIS JR MD INC
Entity type:Organization
Organization Name:RONAL D MANIS JR MD INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICOLA
Authorized Official - Middle Name:J
Authorized Official - Last Name:HUFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-773-3737
Mailing Address - Street 1:1752 W HIGH ST
Mailing Address - Street 2:
Mailing Address - City:PIQUA
Mailing Address - State:OH
Mailing Address - Zip Code:45356-9325
Mailing Address - Country:US
Mailing Address - Phone:937-773-3737
Mailing Address - Fax:937-440-4250
Practice Address - Street 1:1752 W HIGH ST
Practice Address - Street 2:
Practice Address - City:PIQUA
Practice Address - State:OH
Practice Address - Zip Code:45356-9325
Practice Address - Country:US
Practice Address - Phone:937-773-3737
Practice Address - Fax:937-440-4250
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-05
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35043967207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0837527Medicaid
OH0837527Medicaid
OH9934391Medicare PIN