1316069990 NPI number — MATTHEW S IVEY DPM

Table of content: MATTHEW S IVEY DPM (NPI 1316069990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1316069990 NPI number — MATTHEW S IVEY DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IVEY
Provider First Name:
MATTHEW
Provider Middle Name:
S
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
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:
1316069990
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1602 PARKWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-3425
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-979-3343
Provider Business Mailing Address Fax Number:
855-592-3269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 PARKWAY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-3425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-979-3343
Provider Business Practice Location Address Fax Number:
855-592-3269
Provider Enumeration Date:
04/04/2007

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: 213ES0103X , with the licence number:  1825 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 188879403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188879405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188879401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01026742 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 188879402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G9747 . This is a "BCBS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 188879404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com