Organization
SHEILA R MANE MD PC
Active
Organization
SHEILA R MANE MD PC
Active
Other names
SHEILA R MANE MD PC
Organization subpart
No
Provider details
NPI number
Authorized official
DIRENDIA SHACKELFORD (MANAGED CARE SPECIALIST)
(800) 654-0889
Entity
Organization
Contact information
Practice address
1730 E BEVERLY AVE, KINGMAN, AZ 86409-3500
(928) 681-3960
(928) 869-0067
Mailing address
1730 E BEVERLY AVE, KINGMAN, AZ 86409-3500
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
27651
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0352815
OTHER ID NUMBER-COMMERCIAL NUMBER
—
05
—
474742
—
AZ
Enumeration date
11/08/2006
Last updated
08/22/2020
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