1528167244 NPI number — JAMES A MATTER MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528167244 NPI number — JAMES A MATTER MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MATTER

Provider First Name:

JAMES

Provider Middle Name:

A

Provider Name Prefix Text:

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:

1528167244

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

07/14/2010

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

712 SOUTH CASCADE STREET

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FERGUS FALLS

Provider Business Mailing Address State Name:

MN

Provider Business Mailing Address Postal Code:

56537-2813

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

218-736-8000

Provider Business Mailing Address Fax Number:

218-736-8757

Provider First Line Business Practice Location Address:

712 SOUTH CASCADE STREET

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

FERGUS FALLS

Provider Business Practice Location Address State Name:

MN

Provider Business Practice Location Address Postal Code:

56537-2813

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

218-736-8000

Provider Business Practice Location Address Fax Number:

218-736-8757

Provider Enumeration Date:

09/21/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 2085R0202X , with the licence number:  21340 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 106836 . This is a "UCAREMN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 16-00187 . This is a "MEDICA" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 17870MA . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 204990006 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 7705540 , issued by the state of ( SD ) . This identifiers is of the category "MEDICAID".
• Identifier: HP61029 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
• Identifier: 1476582 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 410917444-56537-01 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
• Identifier: 41091744413 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
• Identifier: 510865900 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
• Identifier: 7615484 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
• Identifier: 457 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".
• Identifier: 806646600 , issued by the state of ( ID ) . This identifiers is of the category "MEDICAID".