Active NPI
Mat Enterprises LLC
Doing business as Summit Pharmacy
- Pharmacy
- Holts Summit, MO
National Provider Identifier
1972212496
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacy
- Legal business name
- MAT ENTERPRISES LLC
- Doing business as
- Summit Pharmacy
- Practice address
- 140 Northstar Dr
Holts Summit, MO 65043-1123 - Phone
- (573) 690-0030
- NPI assigned
- Nov 23, 2022
- Last updated
- Nov 23, 2022
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Anthonjy Desha
- Title
- Owner
- Phone
- (573) 690-0030
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacy | 333600000X | NU | Primary |
Addresses
Primary practice location
140 Northstar Dr
Holts Summit, MO 65043-1123
Mailing address
140 Northstar Dr
Holts Summit, MO 65043-1123
Other names 1
- Summit Pharmacy
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MO
Enrollment records 2
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20231226001440 | MO | Part B Supplier - Pharmacy | 0840640363 | Practice locations: Holts Summit, MO |
| O20251020000948 | MO | Part B Supplier - Mass Immunization (Roster Biller Only) | 0840640363 | Practice locations: Holts Summit, MO |
National Provider Directory
National Provider Directory- Tax ID family
- Mat Enterprises LLC
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1669161600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1669161600000",
"number": "1972212496",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "140 NORTHSTAR DR",
"city": "HOLTS SUMMIT",
"state": "MO",
"postal_code": "650431123"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "140 NORTHSTAR DR",
"city": "HOLTS SUMMIT",
"state": "MO",
"postal_code": "650431123",
"telephone_number": "573-690-0030"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "MAT ENTERPRISES LLC",
"organizational_subpart": "NO",
"enumeration_date": "2022-11-23",
"last_updated": "2022-11-23",
"certification_date": "2022-11-23",
"status": "A",
"authorized_official_last_name": "DESHA",
"authorized_official_first_name": "ANTHONJY",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "573-690-0030",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "333600000X",
"taxonomy_group": "",
"desc": "Pharmacy",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Summit Pharmacy",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Holts Summit, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.