Mary Patricia McManmon MD PC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MARY PATRICIA MCMANMON MD PC

Practice address

2714 S 11TH St
Suite a
Niles, MI 49120-4761

Phone

(269) 683-1700

Fax

(269) 683-7038

NPI assigned

Mar 2, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mary P McManmon, MD

Title

Ceo

Phone

(269) 683-1700

Specialties & licenses 2

Addresses

Other names 1

• Advanced Wellness Clinic Doing business as

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Melody A Edwards, LMT

  • Massage Therapist
  • Niles, MI
  • NPI 1841910148
  NPD (past)
• Rosamond C Soanes, D.C.

  • Chiropractor
  • Niles, MI
  • NPI 1659464295
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1299024000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299024000000",
    "number": "1487952214",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2714 S 11TH ST",
            "address_2": "SUITE A",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491204761",
            "telephone_number": "269-683-1700",
            "fax_number": "269-683-7038"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2714 S 11TH ST",
            "address_2": "SUITE A",
            "city": "NILES",
            "state": "MI",
            "postal_code": "491204761",
            "telephone_number": "269-683-1700",
            "fax_number": "269-683-7038"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARY PATRICIA MCMANMON MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-02",
        "last_updated": "2011-03-02",
        "status": "A",
        "authorized_official_last_name": "MCMANMON",
        "authorized_official_first_name": "MARY",
        "authorized_official_middle_name": "P",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "269-683-1700",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Advanced Wellness Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Alex Markovich, MS PT
• Ross Francis Maroney, RPH
• Andrea Maxine Martin, PHARMD
• Martin'S Super Markets of Niles LLC
• Kelly Martinczak, LLSW, LSW
• Brianna Matamoros-Morales
• Victoria Matamoros-Morales
• Stephanie Mattison
• Jordan Maxey
• Tressy Mazumder

• Family Medicine Physician in Niles, MI
• Providers in Niles, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.