| Manc | |
|
4705 Towne Ctr Ste. 201 Saginaw MI 48604-2818 | |
| (989) 799-2770 | |
| (989) 799-2737 |
| Full Name | Manc |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4705 Towne Ctr, Saginaw, Michigan |
| Authorized Official Name and Position | Lisa Macarthur (OFFICE MANAGER) |
| Authorized Official Contact | 9897992770 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Manc 4705 Towne Ctr Ste. 201 Saginaw MI 48604-2818 Ph: (989) 799-2770 | Manc 4705 Towne Ctr Ste. 201 Saginaw MI 48604-2818 Ph: (989) 799-2770 |
| NPI Number | 1003004086 |
|---|---|
| Provider Enumeration Date | 10/04/2007 |
| Last Update Date | 09/25/2020 |
| Certification Date | 09/25/2020 |
| Medicare PECOS PAC ID | 3072561505 |
|---|---|
| Medicare Enrollment ID | O20050111000462 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1003004086 | NPI | - | NPPES |
| 4695041 | Medicaid | MI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084N0400X | Psychiatry & Neurology - Neurology | DM066728 (Michigan) | Primary |
| Provider Name | Debasish Mridha |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1851327159 PECOS PAC ID: 3577511005 Enrollment ID: I20050111000509 |
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