Provider Demographics
NPI:1184689853
Name:ALLUMED, INC.
Entity Type:Organization
Organization Name:ALLUMED, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:MATUKEWICZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-756-2268
Mailing Address - Street 1:5959 SHALLOWFORD RD STE 443
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-2245
Mailing Address - Country:US
Mailing Address - Phone:423-756-2268
Mailing Address - Fax:423-362-5413
Practice Address - Street 1:2001 108TH ST STE 104
Practice Address - Street 2:STE 104
Practice Address - City:GRAND PRAIRIE
Practice Address - State:TX
Practice Address - Zip Code:75050-1429
Practice Address - Country:US
Practice Address - Phone:214-677-0186
Practice Address - Fax:214-677-0157
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX087553601Medicaid
TX102145100OtherFIRST CARE
TX208761102Medicaid
TX10027716OtherAMERIGROUP
TX140634001Medicaid
TX140634001Medicaid
TX=========003OtherHUMANA / TRICARE
TX=========003OtherHUMANA / TRICARE
TX140634001Medicaid