Provider Demographics
NPI:1073868451
Name:MATRIX MEDICAL NETWORK OF ARKANSAS PA
Entity Type:Organization
Organization Name:MATRIX MEDICAL NETWORK OF ARKANSAS PA
Other - Org Name:MATRIX MEDICAL NETWORK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, STRATEGIC OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:ALEXIS
Authorized Official - Middle Name:
Authorized Official - Last Name:MEGEATH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-356-0885
Mailing Address - Street 1:9201 E MOUNTAIN VIEW RD
Mailing Address - Street 2:SUITE 220
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-5199
Mailing Address - Country:US
Mailing Address - Phone:480-862-1700
Mailing Address - Fax:877-506-4560
Practice Address - Street 1:609 SW 8TH ST STE 600
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-8706
Practice Address - Country:US
Practice Address - Phone:480-862-1677
Practice Address - Fax:480-718-7643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-20
Last Update Date:2018-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty