Matrix Medical Network of Idaho, L.L.C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

Legal business name

MATRIX MEDICAL NETWORK OF IDAHO, L.L.C

Practice address

4545 E Shea Blvd
Suite 175
Phoenix, AZ 85028-3074

Phone

(602) 464-5200

Fax

(480) 907-2108

NPI assigned

Aug 26, 2010

Organization subpart

No

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

Authorized official

Name

Thomas R Young, MD

Title

Practice Owner

Phone

(602) 464-5200

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1282780800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1282780800000",
    "number": "1659687812",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4545 E SHEA BLVD",
            "address_2": "SUITE 175",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283074",
            "telephone_number": "602-464-5200"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4545 E SHEA BLVD",
            "address_2": "SUITE 175",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850283074",
            "telephone_number": "602-464-5200",
            "fax_number": "480-907-2108"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MATRIX MEDICAL NETWORK OF IDAHO, L.L.C",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-26",
        "last_updated": "2010-08-26",
        "status": "A",
        "authorized_official_last_name": "YOUNG",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTICE OWNER",
        "authorized_official_telephone_number": "602-464-5200",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Matrix Anesthesia LLC
• Matrix Management LLC
• Matrix Medical Data Processing LLC
• Matrix Medical Data Processing LLC
• Matrix Medical Data Processing LLC
• Matrix Medical Network of Texas LLC
• Christine Marie Matschke, PSYD, LP
• Andrea Dawn Matson, BS
• Jeffrey A Matson, MD
• Stacey Matson, AU.D.

• Family Nurse Practitioner in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• Family Nurse Practitioner in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2010; 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.