Provider Demographics
NPI:1972388783
Name:MATCO INDUSTRIES
Entity Type:Organization
Organization Name:MATCO INDUSTRIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:VAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VINEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-852-7054
Mailing Address - Street 1:204 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:OH
Mailing Address - Zip Code:43140-1490
Mailing Address - Country:US
Mailing Address - Phone:740-852-7054
Mailing Address - Fax:
Practice Address - Street 1:204 MAPLE ST
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:OH
Practice Address - Zip Code:43140-1490
Practice Address - Country:US
Practice Address - Phone:740-852-7054
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-29
Last Update Date:2023-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities