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NPI Code Detail

MEDICARE: JOHN WILLIAM MATHENY

MEDICARE: JOHN WILLIAM MATHENY
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health WorkerNM

General Provider Information

NPI Number : 1700363868
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN WILLIAM MATHENY
Provider Business Mailing Address
First Line : 9201 MONTGOMERY BLVD NE STE V
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-2470
Country : US
Telephone Number : 505-217-1717
Fax Number : 505-213-0041
Provider Business Practice Location Address
First Line : 9201 MONTGOMERY BLVD NE STE V
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87111-2470
Country : US
Telephone Number : 505-217-1717
Fax Number : 505-213-0041
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2018
Last Update Date : 12/04/2025

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