Healthcare Provider Details

I. General information

NPI: 1124884796
Provider Name (Legal Business Name): MATADOR ANESTHESIA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/22/2024
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 S FM 51 STE 900
DECATUR TX
76234-3772
US

IV. Provider business mailing address

PO BOX 1889
MUNCIE IN
47308-1889
US

V. Phone/Fax

Practice location:
  • Phone: 940-245-4306
  • Fax:
Mailing address:
  • Phone: 765-284-0493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNULL

VIII. Authorized Official

Name: ERIC RIEGER
Title or Position: OWNER/PROVIDER
Credential:
Phone: 940-399-9192