Provider Demographics
NPI:1376706085
Name:MATRIX PAIN MANAGEMENT
Entity Type:Organization
Organization Name:MATRIX PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:K
Authorized Official - Last Name:KLEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:989-792-4090
Mailing Address - Street 1:4450 FASHION SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1251
Mailing Address - Country:US
Mailing Address - Phone:989-792-4090
Mailing Address - Fax:989-792-4094
Practice Address - Street 1:4450 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1251
Practice Address - Country:US
Practice Address - Phone:989-792-4090
Practice Address - Fax:989-792-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-03
Last Update Date:2008-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N32000Medicare PIN