1346249406 NPI number — MR. MATTHEW NEIL MELVIN ARNP

Table of content: MR. MATTHEW NEIL MELVIN ARNP (NPI 1346249406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346249406 NPI number — MR. MATTHEW NEIL MELVIN ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MELVIN
Provider First Name:
MATTHEW
Provider Middle Name:
NEIL
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
ARNP
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:
1346249406
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 606
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GLEN ST MARY
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32040-0606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-653-1818
Provider Business Mailing Address Fax Number:
904-653-1814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1847 SW BARNETT WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE CITY
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32025-6957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
386-755-2240
Provider Business Practice Location Address Fax Number:
386-755-6598
Provider Enumeration Date:
07/20/2005

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: 363L00000X , with the licence number:  ARNP 9169903 , 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: 306084500 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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