1306906458 NPI number — MR. THOMAS JOHN MATHEWS R.PH.

Table of content: MR. THOMAS JOHN MATHEWS R.PH. (NPI 1306906458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306906458 NPI number — MR. THOMAS JOHN MATHEWS R.PH.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWS
Provider First Name:
THOMAS
Provider Middle Name:
JOHN
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
R.PH.
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:
1306906458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2623 OLD STABLES DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CELINA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75009-4674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-382-8014
Provider Business Mailing Address Fax Number:
800-874-9179

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10530 JOHN W. ELLIOTT DRIVE
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-387-3500
Provider Business Practice Location Address Fax Number:
800-874-9179
Provider Enumeration Date:
12/11/2006

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: 183500000X , with the licence number:  32678 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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