1235268467 NPI number — MATTHEW P POWERS MD PA

Table of content: (NPI 1235268467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235268467 NPI number — MATTHEW P POWERS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MATTHEW P POWERS MD PA
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:
1235268467
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2420 CAMDEN CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NAPLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34105-2523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-261-1005
Provider Business Mailing Address Fax Number:
239-262-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 HEALTH CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 2400
Provider Business Practice Location Address City Name:
BONITA SPRINGS
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34135-8127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-495-4995
Provider Business Practice Location Address Fax Number:
239-495-4989
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
POWERS
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
P.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
239-495-4995

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  FL 46550 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1255362760 . This is a "PHYSICIAN'S NPI" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 014590500 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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