Provider Demographics
NPI:1679020473
Name:MATRONE PRIMARY CARE LLC
Entity Type:Organization
Organization Name:MATRONE PRIMARY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:K
Authorized Official - Last Name:MATRONE
Authorized Official - Suffix:
Authorized Official - Credentials:ANP
Authorized Official - Phone:919-410-3734
Mailing Address - Street 1:2412 WINDSOR TRL
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615-1200
Mailing Address - Country:US
Mailing Address - Phone:919-410-3734
Mailing Address - Fax:
Practice Address - Street 1:2412 WINDSOR TRL
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27615-1200
Practice Address - Country:US
Practice Address - Phone:919-410-3734
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0607261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care