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NPI Code Detail

MEDICARE: MR. RICHARD JOSEPH MATEYKA PA-C

MEDICARE: MR. RICHARD JOSEPH MATEYKA PA-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
1363A00000XPhysician Assistant699NV
2363AS0400XSurgical Physician AssistantPA699NV

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2970024992OTHERR.R. MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1CC2485OTHERBXBS
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912985367
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RICHARD JOSEPH MATEYKA PA-C
Provider Business Mailing Address
First Line : 2800 E DESERT INN RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3609
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-734-4900
Provider Business Practice Location Address
First Line : 2800 E DESERT INN RD STE 100
Second Line :
City : LAS VEGAS
State : NV
Zip : 89121-3609
Country : US
Telephone Number : 702-731-1616
Fax Number : 702-734-4900
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2006
Last Update Date : 10/15/2018

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Directions to “ MR. RICHARD JOSEPH MATEYKA PA-C” Practice Location

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