NPIMap

Organization Active NPI

Mary Patricia McManmon MD PC

Doing business as Advanced Wellness Clinic

  • Family Medicine Physician
  • Niles, MI
National Provider Identifier
1487952214
Registry record updated Mar 2, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
Legal business name
MARY PATRICIA MCMANMON MD PC
Doing business as
Advanced Wellness Clinic
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
Last updated
Mar 2, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 2, 2011

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

Authorized official

Name
Mary P McManmon, MDNPI 1255363172
Title
Ceo
Phone
(269) 683-1700

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
ChiropractorGroup: 193200000X MULTI-SPECIALTY GROUP 111N00000X
Family Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Q00000X Primary

Addresses

Primary practice location

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

Mailing address

2714 S 11TH St
Suite a
Niles, MI 49120-4761
Phone (269) 683-1700

Other names 1

  • Advanced Wellness Clinic Doing business as

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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"
        }
    ]
}

Other providers in Niles, MI

Sources for this page

  • 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.