Provider Demographics
NPI:1043243801
Name:NAMIHAS, MATTHEW ALEXANDER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ALEXANDER
Last Name:NAMIHAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 61773
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85082-1773
Mailing Address - Country:US
Mailing Address - Phone:928-445-6025
Mailing Address - Fax:928-778-3026
Practice Address - Street 1:802 AINSWORTH DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1623
Practice Address - Country:US
Practice Address - Phone:928-776-0601
Practice Address - Fax:928-776-0620
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3262363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ181976Medicaid
AZWCSKQOtherSUN HEALTH GROUP #
Q76516Medicare UPIN
AZ181976Medicaid