Healthcare Provider Details

I. General information

NPI: 1598080822
Provider Name (Legal Business Name): MATRIX MEDICAL NETWORK OF TEXAS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2010
Last Update Date: 03/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4545 E SHEA BLVD SUITE 175
PHOENIX AZ
85028-3074
US

IV. Provider business mailing address

4545 E SHEA BLVD SUITE 175
PHOENIX AZ
85028-3074
US

V. Phone/Fax

Practice location:
  • Phone: 602-464-5200
  • Fax: 480-907-2108
Mailing address:
  • Phone: 602-464-5200
  • Fax: 480-907-2108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: LINDA LEOLA BIVINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 602-464-5251