1023442241 NPI number — MRS. ELIZABETH BROADBENT MATTHEWS RN

Table of content: MRS. ELIZABETH BROADBENT MATTHEWS RN (NPI 1023442241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023442241 NPI number — MRS. ELIZABETH BROADBENT MATTHEWS RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATTHEWS
Provider First Name:
ELIZABETH
Provider Middle Name:
BROADBENT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROADBENT
Provider Other First Name:
ELIZABETH
Provider Other Middle Name:
MALLORY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RN
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023442241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/23/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 770
Provider Second Line Business Mailing Address:
1475 EAST LIBERTY STREET
Provider Business Mailing Address City Name:
YORK
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29745-0770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-684-9916
Provider Business Mailing Address Fax Number:
803-684-1903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18 SPRUCE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
YORK
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29745-0770
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-684-1905
Provider Business Practice Location Address Fax Number:
803-684-1907
Provider Enumeration Date:
08/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163WS0200X , with the licence number:  102438 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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