MEDICARE: MATTHEW S. KAATZ, M.D. P.C.

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
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1912228297
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEW S. KAATZ, M.D. P.C.

Provider Business Mailing Address
First Line	:	101 1ST ST NW
Second Line	:
City	:	PULASKI
State	:	VA
Zip	:	24301-5605
Country	:	US
Telephone Number	:	540-980-0550
Fax Number	:	540-980-5010

Provider Business Practice Location Address
First Line	:	101 1ST ST NW
Second Line	:
City	:	PULASKI
State	:	VA
Zip	:	24301-5605
Country	:	US
Telephone Number	:	540-980-0552
Fax Number	:	540-980-5010

Authorized Official
Title or Position	:	INSURANCE CLERK
Name	:	MRS. CAROLYN P GARDNER
Credential	:
Telephone Number	:	540-980-0550

Provider Enumeration Date	:	06/21/2010
Last Update Date	:	06/24/2010

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