Active NPI
Delores Genevieve Matz, LCMT
- Contractor
- Elk River, MN
National Provider Identifier
1215104211
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Contractor
- License
- MT 08 - 50
- Practice address
- 200 5TH St NW
Suite D
Elk River, MN 55330-1917 - Phone
- (763) 300-1022
- Fax
- (763) 633-7827
- NPI assigned
- May 9, 2008
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Contractor | 171W00000X | MT 08 - 50 | MN | Primary |
Addresses
Primary practice location
200 5TH St NW
Suite D
Elk River, MN 55330-1917
Mailing address
200 5TH St NW
Suite D
Elk River, MN 55330-1917
Phone (763) 300-1022
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MT 08 - 50 | MN | MD | Contractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1210291200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1210291200000",
"number": "1215104211",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "200 5TH ST NW",
"address_2": "SUITE D",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301917",
"telephone_number": "763-300-1022",
"fax_number": "763-633-7827"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "200 5TH ST NW",
"address_2": "SUITE D",
"city": "ELK RIVER",
"state": "MN",
"postal_code": "553301917",
"telephone_number": "763-300-1022",
"fax_number": "763-633-7827"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MATZ",
"first_name": "DELORES",
"middle_name": "GENEVIEVE",
"credential": "LCMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-05-09",
"last_updated": "2008-05-09",
"status": "A"
},
"taxonomies": [
{
"code": "171W00000X",
"taxonomy_group": "",
"desc": "Contractor",
"state": "MN",
"license": "MT 08 - 50",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk River, MN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 9, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.