Provider Demographics
NPI:1124006986
Name:MATTHEWS INC
Entity Type:Organization
Organization Name:MATTHEWS INC
Other - Org Name:MATTHEWS DRUG STORE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:SPENCER
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:910-592-3121
Mailing Address - Street 1:408 NORTHEAST BLVD
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:NC
Mailing Address - Zip Code:28328-2434
Mailing Address - Country:US
Mailing Address - Phone:910-592-3121
Mailing Address - Fax:910-592-5111
Practice Address - Street 1:408 NORTHEAST BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NC
Practice Address - Zip Code:28328-2434
Practice Address - Country:US
Practice Address - Phone:910-592-3121
Practice Address - Fax:910-592-5111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-03
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 332BC3200X
NC003350332BP3500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0476POtherBLUE CROSS BLUE SHIELD
NC3564Medicaid
NC7700182Medicaid
NC0484120001Medicare ID - Type UnspecifiedMEDICARE
NC3564Medicaid