Provider Demographics
NPI:1639501604
Name:A.J. MATHEWS INC. DBA STAR WELLNESS TEXAS PANHANDLE
Entity Type:Organization
Organization Name:A.J. MATHEWS INC. DBA STAR WELLNESS TEXAS PANHANDLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALTHA
Authorized Official - Middle Name:JILL
Authorized Official - Last Name:MATHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-331-7969
Mailing Address - Street 1:1102 I-40 W REAR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79102-2667
Mailing Address - Country:US
Mailing Address - Phone:806-331-7969
Mailing Address - Fax:806-468-9542
Practice Address - Street 1:1102 I-40 W REAR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79102-2667
Practice Address - Country:US
Practice Address - Phone:806-331-7969
Practice Address - Fax:806-468-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX171W00000X, 293D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes293D00000XLaboratoriesPhysiological Laboratory
No171W00000XOther Service ProvidersContractorGroup - Single Specialty