Basic Information
| Provider Information | |||||||||
| NPI: | 1649230145 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MATHEWS | ||||||||
| FirstName: | ARUN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 400 W 4TH ST | ||||||||
| Address2: | MCH CMIO OFFICE | ||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797615045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326402408 | ||||||||
| FaxNumber: | 4326404606 | ||||||||
| Practice Location | |||||||||
| Address1: | 500 W 4TH ST | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | TX | ||||||||
| PostalCode: | 797615001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4326402834 | ||||||||
| FaxNumber: | 4326402897 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 11/26/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD20050505 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | N2188 | TX | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | N2188 | TX | Y | Allopathic & Osteopathic Physicians | Hospitalist |
ID Information
| ID | Type | State | Issuer | Description | 97431201 | 01 | NM | HOBBS AHCCCS | OTHER | 79285864 | 05 | NM | MEDICAID | P00268426 | 01 | NM | RAILROAD MEDICARE | OTHER | NM009X13 | 01 | NM | BLUE CROSS BLUE SHIELD | OTHER |