=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336562495
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WALTER E MATTHEWS & ASSOC INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/27/2014
-----------------------------------------------------
Last Update Date | 01/27/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1327 FIFTH STREET
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-627-0899
-----------------------------------------------------
Fax | 419-627-0399
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1327 FIFTH STREET
-----------------------------------------------------
City | SANDUSKY
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44870
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 419-627-0899
-----------------------------------------------------
Fax | 419-627-0399
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | WALTER EARL MATTHEWS
-----------------------------------------------------
Credential | AGENT
-----------------------------------------------------
Telephone | 419-627-0899
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251X00000X
-----------------------------------------------------
Taxonomy Name | Supports Brokerage Agency
-----------------------------------------------------
License Number | 12440
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------