1326100645 NPI number — RUTH M MATHEWS PH.D.

Table of content: RUTH M MATHEWS PH.D. (NPI 1326100645)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326100645 NPI number — RUTH M MATHEWS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWS
Provider First Name:
RUTH
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

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:
1326100645
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1707 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LA CROSSE
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54601-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
608-785-0001
Provider Business Mailing Address Fax Number:
608-785-0002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
66 E 3RD ST
Provider Second Line Business Practice Location Address:
201
Provider Business Practice Location Address City Name:
WINONA
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55987-3478
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-452-7292
Provider Business Practice Location Address Fax Number:
507-457-9887
Provider Enumeration Date:
12/14/2006

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: 103TC0700X , with the licence number:  LP0177 , 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: 938548700 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117761 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 974T9MA . This is a "BCBS-MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP17766 . This is a "HEALTHPARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 731291012003 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com