Provider Demographics
NPI:1205541059
Name:MATHENY, PATRICK B
Entity type:Individual
Prefix:MR
First Name:PATRICK
Middle Name:B
Last Name:MATHENY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:216 REDWOOD ST SE
Mailing Address - Street 2:
Mailing Address - City:BEACH CITY
Mailing Address - State:OH
Mailing Address - Zip Code:44608-9301
Mailing Address - Country:US
Mailing Address - Phone:330-756-2962
Mailing Address - Fax:
Practice Address - Street 1:216 REDWOOD ST SE
Practice Address - Street 2:
Practice Address - City:BEACH CITY
Practice Address - State:OH
Practice Address - Zip Code:44608-9301
Practice Address - Country:US
Practice Address - Phone:330-756-2962
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7610133343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0194071Medicaid