Basic Information
| Provider Information | |||||||||
| NPI: | 1083840771 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. MATTHEW DIAGNOSTIC CLINIC, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7111 HARWIN DR STE 125 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770362130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328773465 | ||||||||
| FaxNumber: | 7137841725 | ||||||||
| Practice Location | |||||||||
| Address1: | 7111 HARWIN DR STE 125 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770362130 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8328773465 | ||||||||
| FaxNumber: | 7137841725 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2009 | ||||||||
| LastUpdateDate: | 10/29/2009 | ||||||||
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| AuthorizedOfficialLastName: | MBA | ||||||||
| AuthorizedOfficialFirstName: | MATTHEW | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 8328773465 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 335V00000X | N | Suppliers | Portable X-Ray Supplier | 246W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Technologists, Technicians & Other Technical Service Providers | Technician, Cardiology |
No ID Information.