1679535231 NPI number — ZEEBA MATHEWS MD

Table of content: ZEEBA MATHEWS MD (NPI 1679535231)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679535231 NPI number — ZEEBA MATHEWS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHEWS
Provider First Name:
ZEEBA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1679535231
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2200 W ILLINOIS AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79701-6407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-684-0052
Provider Business Mailing Address Fax Number:
405-844-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2200 W ILLINOIS AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79701-6407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-686-5252
Provider Business Practice Location Address Fax Number:
432-685-4950
Provider Enumeration Date:
04/06/2006

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: 207R00000X , with the licence number:  MD20060004 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: N6922 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0002X , with the licence number: N6922 , 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: 04381401 . This is a "HOBBS AHCCCS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 10506764 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00310620 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: P00398468 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NM009X77 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 280123501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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