Healthcare Provider Details

I. General information

NPI: 1902308489
Provider Name (Legal Business Name): SCOTT R MATHIS MAINTENANCE & CONSTRUCTION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7046 STOWE CIRCLE
FOUNTAIN CO
80817
US

IV. Provider business mailing address

7046 STOWE CIRCLE
FOUNTAIN CO
80817
US

V. Phone/Fax

Practice location:
  • Phone: 719-641-3999
  • Fax:
Mailing address:
  • Phone: 719-641-3999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171WH0202X
TaxonomyHome Modifications Contractor
License Number
License Number State

VIII. Authorized Official

Name: SCOTT MATHIS
Title or Position: OWNER/OPERATOR
Credential:
Phone: 719-641-3999