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General NPI Number Information
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NPI Number | 1093099012
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Entity Type | Organization
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Legal Business Name | ELIZABETH S. MATEOS-TIONGCO
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Dates
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Enumeration Date | 10/10/2011
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Last Update Date | 10/10/2011
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Provider Practice Location Address
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Address Line | 195 E BROAD ST
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City | LYONS
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State | IN
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Zip | 47443-9502
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Country | US
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Telephone | 812-659-2030
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Fax | 812-659-7601
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Provider Business Mailing Address
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Address Line | PO BOX 236
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City | LYONS
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State | IN
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Zip | 47443-0236
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Country | US
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Telephone | 812-659-2030
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Fax | 812-659-7601
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Authorized Official
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Title or Position | OWNER
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Name | DR. ELIZABETH SANCHEZ MATEOS
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Credential | M.D.
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Telephone | 812-659-2030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01033055B
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | 01033055A
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License Number State | IN
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