Provider Demographics
NPI:1295791002
Name:MATTHEW ONCOLOGY ASSOCIATES
Entity type:Organization
Organization Name:MATTHEW ONCOLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:OGDEN
Authorized Official - Suffix:
Authorized Official - Credentials:RN OCN
Authorized Official - Phone:920-458-7433
Mailing Address - Street 1:1621 N TAYLOR DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081
Mailing Address - Country:US
Mailing Address - Phone:920-458-7433
Mailing Address - Fax:920-452-3594
Practice Address - Street 1:1621 N TAYLOR DR
Practice Address - Street 2:SUITE 100
Practice Address - City:SHEBOYGAN
Practice Address - State:WI
Practice Address - Zip Code:53081
Practice Address - Country:US
Practice Address - Phone:920-458-7433
Practice Address - Fax:920-452-3594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-21
Last Update Date:2009-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI21270600Medicaid
WI60260Medicare ID - Type Unspecified