Healthcare Provider Details

I. General information

NPI: 1811803893
Provider Name (Legal Business Name): MATRIX MEDICAL DATA PROCESSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20601 N 19TH AVE STE 130
PHOENIX AZ
85027-3587
US

IV. Provider business mailing address

20601 N 19TH AVE STE 130
PHOENIX AZ
85027-3587
US

V. Phone/Fax

Practice location:
  • Phone: 877-564-3627
  • Fax:
Mailing address:
  • Phone: 877-564-3627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: STEPHANIE PETERSON
Title or Position: MANAGER, CREDENTIALING ENROLLMENT
Credential:
Phone: 877-564-3627