# MANCHIN CLINIC OF BRIDGEPORT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386019222
- **Authorized official:** MR. JOHN MANCHIN III (OWNER)
- **Authorized official phone:** (304) 367-9170

## Contact information

- **Practice address:** 409 W MAIN ST, BRIDGEPORT, WV 26330-1752
- **Practice address phone:** (304) 367-9170
- **Mailing address:** 409 W MAIN ST, BRIDGEPORT, WV 26330-1752

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 12/03/2015
- **Last updated:** 09/15/2025