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General NPI Number Information
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NPI Number | 1447475983
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Entity Type | Organization
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Legal Business Name | ST MATTHEWS NEUROLOGY PSC
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Dates
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Enumeration Date | 04/17/2007
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 1850 STATE ST
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City | NEW ALBANY
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State | IN
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Zip | 47150-4990
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Country | US
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Telephone | 502-899-1193
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Fax | 502-897-7233
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Provider Business Mailing Address
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Address Line | 134 TRAVOIS RD
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City | LOUISVILLE
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State | KY
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Zip | 40207-1673
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Country | US
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Telephone | 502-899-1193
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Fax | 502-897-7233
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN MELTON
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Credential | MD
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Telephone | 502-899-1193
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084N0400X
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Taxonomy Name | Neurology Physician
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License Number | 26502
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License Number State | KY
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