NPIMap

Organization Active NPI

Harry B. Matossian

  • Ambulatory Surgical Clinic/Center
  • Ukiah, CA
National Provider Identifier
1003814229
Registry record updated Sep 23, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
1100514 Issued in CA
Legal business name
HARRY B. MATOSSIAN
Practice address
234 Hospital Dr
Ukiah, CA 95482-4560
Phone
(707) 462-3190
Fax
(707) 462-4647
NPI assigned
Jul 12, 2005
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Sep 23, 2014

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Harry Berj Matossian, M.D.
Title
Owner
Phone
(707) 462-3190

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 1100514 CA Primary

Addresses

Primary practice location

234 Hospital Dr
Ukiah, CA 95482-4560

Mailing address

234 Hospital Dr
Suite a
Ukiah, CA 95482-4560
Phone (707) 462-3190

Other identifiers 4

IdentifierTypeStateIssuer
AS1639OtherCABLUE CROSS OF CALIFORNIA
05-C0001639OtherCAMEDICARE LICENSE NUMBER
P00117803OtherCARAILROAD MEDICARE
ZZZH23012OtherCABLUE SHIELD OF CALIFORNIA

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1121126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1411430400000",
    "number": "1003814229",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "234 HOSPITAL DR",
            "address_2": "SUITE A",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824560",
            "telephone_number": "707-462-3190",
            "fax_number": "707-462-4647"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "234 HOSPITAL DR",
            "city": "UKIAH",
            "state": "CA",
            "postal_code": "954824560",
            "telephone_number": "707-462-3190",
            "fax_number": "707-462-4647"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "HARRY B. MATOSSIAN",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-07-12",
        "last_updated": "2014-09-23",
        "status": "A",
        "authorized_official_last_name": "MATOSSIAN",
        "authorized_official_first_name": "HARRY",
        "authorized_official_middle_name": "BERJ",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "707-462-3190",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "CA",
            "license": "1100514",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS OF CALIFORNIA",
            "identifier": "AS1639",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE LICENSE NUMBER",
            "identifier": "05-C0001639",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "P00117803",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD OF CALIFORNIA",
            "identifier": "ZZZH23012",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Ukiah, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.