1306920657 NPI number — DR. ARTHUR JEREMY MATAS MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306920657 NPI number — DR. ARTHUR JEREMY MATAS MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MATAS

Provider First Name:

ARTHUR

Provider Middle Name:

JEREMY

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1306920657

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/26/2012

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

420 DELAWARE ST SE

Provider Second Line Business Mailing Address:

MMC 195-UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Business Mailing Address City Name:

MINNEAPOLIS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

55455

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

612-626-6100

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

516 DELAWARE STREET SE, CLINIC 2A

Provider Second Line Business Practice Location Address:

UNIVERSITY OF MINNESOTA PHYSICIANS

Provider Business Practice Location Address City Name:

MINNEAPOLIS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

55455

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

612-626-6100

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

10/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 204F00000X , with the licence number:  20886 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 208600000X , with the licence number: 20886 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 604629 . This is a "ARAZ" identifier . This identifiers is of the category "OTHER".
• Identifier: 17-22560 . This is a "MEDICA CHOICE" identifier . This identifiers is of the category "OTHER".
• Identifier: 31381300 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: HP22189 . This is a "HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 1009232 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2099910 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 101556 . This is a "UCARE" identifier . This identifiers is of the category "OTHER".
• Identifier: 2T099MA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
• Identifier: 612288400 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 7762290 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: 0977074 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
• Identifier: 10757 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
• Identifier: 17-00026 . This is a "MEDICA PRIMARY" identifier . This identifiers is of the category "OTHER".