1881684546 NPI number — MATTHEW L MAUNU MD

Table of content: MATTHEW L MAUNU MD (NPI 1881684546)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881684546 NPI number — MATTHEW L MAUNU MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAUNU
Provider First Name:
MATTHEW
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1881684546
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 MT HIGHWAY 91 S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DILLON
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59725-7379
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-683-3000
Provider Business Mailing Address Fax Number:
406-683-3027

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 MT HIGHWAY 91 S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DILLON
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59725-7379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-683-3000
Provider Business Practice Location Address Fax Number:
406-683-3027
Provider Enumeration Date:
10/25/2005

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: 208600000X , with the licence number:  44007 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2114153 . This is a "FIRST HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 43F36MA . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020049623 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 151703 . This is a "U CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 986426100 . This is a "MEDICAL ASSISTANCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: C11369 . This is a "RR MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1027346 . This is a "PREFERRED ONE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1285221 . This is a "ARAZ GROUP AMERICAS PPO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1700538 . This is a "MEDICA HEALTH PLANS" identifier . This identifiers is of the category "OTHER".




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