Healthcare Provider Details

I. General information

NPI: 1588896849
Provider Name (Legal Business Name): MATRIX NETWORK MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/19/2009
Last Update Date: 08/19/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

409 E CALIFORNIA AVE STE 210
OKLAHOMA CITY OK
73104-4226
US

IV. Provider business mailing address

409 E CALIFORNIA AVE STE 210
OKLAHOMA CITY OK
73104-4226
US

V. Phone/Fax

Practice location:
  • Phone: 405-600-1290
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: THOMAS FONDREN
Title or Position: MANAGING DIRECTOR
Credential:
Phone: 405-600-1290