1144279670 NPI number — MATRIX OCCUPATIONAL HEALTH P.C.

Table of content: (NPI 1144279670)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144279670 NPI number — MATRIX OCCUPATIONAL HEALTH P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATRIX OCCUPATIONAL HEALTH P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1144279670
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2145 E BASELINE RD STE 101
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85283-1546
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-705-8558
Provider Business Mailing Address Fax Number:
480-776-1605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
217 GLENSFORD DR
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
FAYETTEVILLE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28314-0892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-849-5609
Provider Business Practice Location Address Fax Number:
910-483-3959
Provider Enumeration Date:
05/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GORBATENKO
Authorized Official First Name:
MIKHAIL
Authorized Official Middle Name:
Authorized Official Title or Position:
AUTHORIZED OFFICAL
Authorized Official Telephone Number:
888-705-8558

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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