Provider Demographics
NPI:1598531691
Name:MATTHEW 25 AIDS SERVICES INC
Entity Type:Organization
Organization Name:MATTHEW 25 AIDS SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOLFORK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-826-0200
Mailing Address - Street 1:452 OLD CORYDON RD
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-4645
Mailing Address - Country:US
Mailing Address - Phone:270-826-0200
Mailing Address - Fax:270-826-0212
Practice Address - Street 1:101 NW 1ST ST STE 201
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47708-1259
Practice Address - Country:US
Practice Address - Phone:866-607-6590
Practice Address - Fax:270-826-0200
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MATTHEW 25 AIDS SERVICES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-11-29
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN60006908AOtherIN LICENSE PERMIT #