Basic Information
| Provider Information | |||||||||
| NPI: | 1699714204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MATHUS | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | C | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 180 S 3RD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182330017 | ||||||||
| FaxNumber: | 6182330251 | ||||||||
| Practice Location | |||||||||
| Address1: | 180 S 3RD ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BELLEVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 622201952 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6182330017 | ||||||||
| FaxNumber: | 6182330251 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2006 | ||||||||
| LastUpdateDate: | 03/19/2008 | ||||||||
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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 | 207V00000X | 036061379 | IL | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 036061379 | 05 | IL | MEDICAID | 0707047 | 01 | IL | UHC MEDICARE COMPLETE | OTHER | 2113V3948 | 01 | IL | GROUP HEALTH PLAN | OTHER | 8215125 | 01 | IL | BLUE CROSS BLUE SHIELD | OTHER | 111843 | 01 | MO | ALLIANCE BC/BS | OTHER |