1871698043 NPI number — DR. MATTHEW C MITCHELL DMD

Table of content: DR. MATTHEW C MITCHELL DMD (NPI 1871698043)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871698043 NPI number — DR. MATTHEW C MITCHELL DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
MATTHEW
Provider Middle Name:
C
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1871698043
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/26/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
211 HIGH POINT CT
Provider Second Line Business Mailing Address:
SUITE 500
Provider Business Mailing Address City Name:
MT WASHINGTON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40047-5528
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-538-2400
Provider Business Mailing Address Fax Number:
502-538-2403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
211 HIGH POINT CT
Provider Second Line Business Practice Location Address:
SUITE 500
Provider Business Practice Location Address City Name:
MT WASHINGTON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40047-5528
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-538-2400
Provider Business Practice Location Address Fax Number:
502-538-2403
Provider Enumeration Date:
09/13/2006

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: 1223P0221X , with the licence number:  806 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7100071020 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com