Individual ProviderMarc MankoPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersPractice Address190 E Bannock St, Boise, ID 83712-6241(208) 381-2235(208) 381-8752PECOS EnrollmentBased on the most recent information from CMS, provider Marc Manko is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 9:43 AM.Profile DetailsProvider ID1366964272Provider TypeIndividualFull NameManko, MarcCredentialPA-CGenderMaleSole ProprietorYesEnumeration Date7/12/2017Last Updated6/25/2024Contact InformationPractice LocationPractice Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-2235Fax(208) 381-4556Mailing LocationMailing Address190 E Bannock St, Boise, ID 83712-6241Phone(208) 381-8752FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode363A00000XPrimaryDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicensePA-1529IdahoCode363A00000XDescriptionPhysician AssistantPhysician Assistants & Advanced Practice Nursing ProvidersLicenseUnlisted IssuerCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer