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General NPI Number Information
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NPI Number | 1467631945
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Entity Type | Organization
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Legal Business Name | HUNTINGTON MEDICAL GROUP PC
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Dates
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Enumeration Date | 10/31/2007
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Last Update Date | 10/13/2010
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Provider Practice Location Address
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Address Line | 1601 N JEFFERSON ST
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City | HUNTINGTON
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State | IN
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Zip | 46750-1404
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Country | US
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Telephone | 260-356-4005
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Fax | 260-356-3501
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Provider Business Mailing Address
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Address Line | 1601 N JEFFERSON ST
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City | HUNTINGTON
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State | IN
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Zip | 46750-1404
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Country | US
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Telephone | 260-356-4005
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Fax | 260-356-3501
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Authorized Official
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Title or Position | OWNER
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Name | DR. JOHN C. MATHEW
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Credential | M.D.
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Telephone | 260-356-4005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01053659A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 01035103A
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License Number State | IN
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