Antonio S Manalo, MD
Individual provider Active NPI Family Medicine Physician · Springfield, CO
NPI 1609944313 · NPPES record last updated Jan 17, 2011
Key facts
- NPI
- 1609944313
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 21312 (CO)
- Practice address
- 900 Church St
Springfield, CO 81073 - Phone
- (719) 523-6221
- Fax
- (719) 523-4290
- NPI assigned
- Dec 1, 2006
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 21312 | CO | MD | Family Medicine Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 21312 | CO | Yes |
Addresses
Primary practice location
900 Church St
Springfield, CO 81073
Mailing address
373 E 10TH Ave
Springfield, CO 81073
Phone (719) 523-6221
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01213123 | Medicaid | CO |
Other providers in Springfield, CO
- Ralph Edward Holsworth Jr.
- Jenna Homsher
- Janette Lorena S Javier
- Chambrey Ann Johnson
- Kyle L Lasley
- Cynthia Lynn Packard
- Jacia Dawn Piper
- Poudre Valley Medical Group, LLC
- Prairie Clinic LLC
- R & R Family Pharmacy LLC
All providers in Springfield, CO · Family Medicine Physician in Colorado
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 17, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.