1275560435 NPI number — MARK W MATHEWS

Table of content: (NPI 1710597505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275560435 NPI number — MARK W MATHEWS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWS
Provider First Name:
MARK
Provider Middle Name:
W
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1275560435
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8319 EMBASSY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PORT RICHEY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
727-819-0440
Provider Business Mailing Address Fax Number:
727-819-9795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8319 EMBASSY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PORT RICHEY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
727-819-0440
Provider Business Practice Location Address Fax Number:
727-819-9795
Provider Enumeration Date:
06/26/2006

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: 152W00000X , with the licence number:  OPC1388 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: DN0867 . This is a "RAILROAD GROUP PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0763230001 . This is a "PALMETTO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 19872 . This is a "INDIVIDUAL BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 33801 . This is a "GROUP BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 232279 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 084932400 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 410022395 . This is a "RAILROAD GROUP MEMBER PTAN" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1518098102 . This is a "RAILROAD GROUP NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 410022395 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1275560435 . This is a "MEDICARE NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 1275560435 . This is a "RAILROAD INDIVIDUAL NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 110527 . This is a "ECPA-EYE MED" identifier . This identifiers is of the category "OTHER".




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