1841222189 NPI number — DR. BILL JEFFREY MATHIAS MD

Table of content: DR. BILL JEFFREY MATHIAS MD (NPI 1841222189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841222189 NPI number — DR. BILL JEFFREY MATHIAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHIAS
Provider First Name:
BILL
Provider Middle Name:
JEFFREY
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATHIAS
Provider Other First Name:
BILL
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1841222189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/19/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3624 BUCKINGHAM DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NACOGDOCHES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75965
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-569-6041
Provider Business Mailing Address Fax Number:
936-560-6093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4800 NE STALLINGS
Provider Second Line Business Practice Location Address:
STE 1100
Provider Business Practice Location Address City Name:
NACOGDOCHES
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75965
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-560-4100
Provider Business Practice Location Address Fax Number:
936-560-6093
Provider Enumeration Date:
07/07/2006

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: 208100000X , with the licence number:  J8312 , 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: 116234904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0017KW . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com