T.R. Mationg MD PA

Primary specialty

Exclusive Provider OrganizationTaxonomy code 302F00000X

Legal business name

T.R. MATIONG MD PA

Practice address

10201 State Road 52
Hudson, FL 34669-3071

Phone

(727) 857-1818

Fax

(727) 857-1609

NPI assigned

Oct 13, 2011

Organization subpart

No

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

Authorized official

Name

Dr. Teodulo R Mationg Jr., M.D.

Title

Practitioner

Phone

(727) 857-1818

Specialties & licenses 1

Addresses

Other identifiers 4

Other names 1

• Mationg Medical Center Other name

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

{
    "created_epoch": "1318464000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373241600000",
    "number": "1770868416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10201 STATE ROAD 52",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "346693071",
            "telephone_number": "727-857-1818",
            "fax_number": "727-857-1609"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10201 STATE ROAD 52",
            "city": "HUDSON",
            "state": "FL",
            "postal_code": "346693071",
            "telephone_number": "727-857-1818",
            "fax_number": "727-857-1609"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "T.R. MATIONG MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-10-13",
        "last_updated": "2013-07-08",
        "status": "A",
        "authorized_official_last_name": "MATIONG",
        "authorized_official_first_name": "TEODULO",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "PRACTITIONER",
        "authorized_official_telephone_number": "727-857-1818",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "302F00000X",
            "taxonomy_group": "",
            "desc": "Exclusive Provider Organization",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "HUMANA PPO",
            "identifier": "593613012",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "WELLCARE",
            "identifier": "451024515",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD",
            "identifier": "10624",
            "state": null
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UHCARE",
            "identifier": "05931",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Mationg Medical Center",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Exclusive Provider Organization in Hudson, FL
• Providers in Hudson, FL by specialty
• Exclusive Provider Organization in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2013; 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.