Basic Information
| Provider Information | |||||||||
| NPI: | 1144270810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATTHEWS | ||||||||
| FirstName: | SHIRNETT | ||||||||
| MiddleName: | MAY | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1 INDEPENDENCE PT STE 212 | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296154536 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8647976303 | ||||||||
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| Practice Location | |||||||||
| Address1: | 900 W FARIS RD | ||||||||
| Address2: | |||||||||
| City: | GREENVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 296054255 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8646793900 | ||||||||
| FaxNumber: | 8646793901 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/11/2006 | ||||||||
| LastUpdateDate: | 01/31/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0001X | 32067 | SC | Y | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology |
ID Information
| ID | Type | State | Issuer | Description | 2742861000 | 01 | NJ | AMERIHEALTH - NJOS # | OTHER | P00416963 | 01 | NJ | RAILROAD MEDICARE | OTHER | 1592771 | 01 | NJ | CIGNA PROVIDER # | OTHER | 3K4198 | 01 | NJ | HEALTH NET PROVIDER # | OTHER | P00613891 | 01 | NJ | RAILROAD MEDICARE PTAN | OTHER | 320672 | 05 | SC | MEDICAID | 0100790 | 05 | NJ | MEDICAID | 316663 | 01 | NJ | AMERIGROUP PROVIDER # | OTHER |