Provider Demographics
NPI:1104004167
Name:MATTHEW J HURST
Entity Type:Organization
Organization Name:MATTHEW J HURST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:J
Authorized Official - Last Name:HURST
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:330-343-0145
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:
Mailing Address - City:NEW PHILADELPHIA
Mailing Address - State:OH
Mailing Address - Zip Code:44663-0710
Mailing Address - Country:US
Mailing Address - Phone:330-343-0145
Mailing Address - Fax:330-343-1240
Practice Address - Street 1:163 W HIGH AVE
Practice Address - Street 2:
Practice Address - City:NEW PHILADELPHIA
Practice Address - State:OH
Practice Address - Zip Code:44663-3840
Practice Address - Country:US
Practice Address - Phone:330-343-0145
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-01
Last Update Date:2008-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3989460001Medicare NSC