M & T Dermatology Services Llc

LBN: M & T Dermatology Services Llc
M & T Dermatology Services Llc is an health care organization with primary practice located at 2829 S Jackson Ave , Joplin MO 64804-2525. The organization recently has only one registered license in Allopathic & Osteopathic Physicians / Dermatology, which is considered as the primary health care specialty. M & T Dermatology Services Llc can be contacted via phone (417) 624-0440, or through Matlock, Mark Stephen via phone (417) 624-0440.

Contact Information

Primary practice address
2829 S Jackson Ave Joplin MO 64804-2525
Phone: (417) 624-0440
Fax: (417) 624-9652
Website:
Map and Directions
Authorized official contact:
Name: Matlock, Mark Stephen Doctor of Medicine (MD)
Phone: (417) 624-0440

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Dermatology 207N00000X

Profile Details

NPI number 1083602015
LBN Legal business name M & T Dermatology Services Llc
DBA Doing business as
Authorized official Matlock, Mark Stephen Doctor of Medicine (MD)
Entity Organization
Organization subpart 1 No
Enumeration date Oct 13th, 2005
Last updated Nov 19th, 2008 - about 18 years ago

1 Some organizations, which are providing health care services, may consist of units or departments that provide different types of health care services or have several separate physical locations, where health care service is provided. These units, departments or physical locations are not themselves legal entities. However, each of them is part of the organization, which is a legal entity. The organization may decide whether its subparts, if it has any, should have their own NPI numbers. In case a subpart conducts any HIPAA standard transactions by itself, without its parent's involvement, it must have its own NPI number.

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Identifiers

StateTypeNumberIssuer
All States NPI 1083602015 NPPES
Missouri MEDICAID 506068501
Missouri Other DA0571

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