Provider Demographics
NPI:1093872202
Name:MATRIA HEALTHCARE, INC.
Entity Type:Organization
Organization Name:MATRIA HEALTHCARE, INC.
Other - Org Name:MATRIA LABS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:HINTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-767-4600
Mailing Address - Street 1:1850 PARKWAY PL SE FL 12
Mailing Address - Street 2:ATTN REIMBURSEMENT
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-4439
Mailing Address - Country:US
Mailing Address - Phone:770-767-4999
Mailing Address - Fax:770-767-7420
Practice Address - Street 1:1850 PARKWAY PL SE FL 12
Practice Address - Street 2:ATTN REIMBURSEMENT
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-4439
Practice Address - Country:US
Practice Address - Phone:770-767-4999
Practice Address - Fax:770-767-7420
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH=========002OtherMEDICAL MUTUAL OH
KS9004163Medicare ID - Type UnspecifiedMEDICARE KS