1326157595 NPI number — BETH MATHEWS APN

Table of content: BETH MATHEWS APN (NPI 1326157595)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326157595 NPI number — BETH MATHEWS APN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWS
Provider First Name:
BETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN
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:
1326157595
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/12/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1504 PATTON DR
Provider Second Line Business Mailing Address:
UNIT 2
Provider Business Mailing Address City Name:
MAHOMET
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
61853-8126
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
217-784-2633
Provider Business Mailing Address Fax Number:
217-590-0272

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1504 PATTON DR
Provider Second Line Business Practice Location Address:
UNIT 2
Provider Business Practice Location Address City Name:
MAHOMET
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
61853-8126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
217-784-2633
Provider Business Practice Location Address Fax Number:
217-590-0272
Provider Enumeration Date:
08/30/2006

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: 363LF0000X , with the licence number:  209000456 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP2300X , with the licence number: 209000456 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 041-177521 . This is a "ILL. RN LICENSE#" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: F400299982 . This is a "MEDICARE PTAN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 209000456 . This is a "ILL. APN LICENSE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 30227022 . This is a "ANCC CREDENTIAL #" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 5711821 . This is a "FIRST HEALTH/COVENTRY" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: S67258 . This is a "MEDICARE PIN" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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