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General NPI Number Information
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NPI Number | 1710629829
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Entity Type | Individual
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Provider Name | MR. MATTHEW JOEL PAULSEN SR.
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Gender | Male
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Dates
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Enumeration Date | 04/09/2022
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Last Update Date | 04/09/2022
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Provider Practice Location Address
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Address Line | 212 N CREEK BLVD
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City | GREENWOOD
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State | SC
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Zip | 29649-9006
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Country | US
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Telephone | 864-310-9500
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Fax | 864-719-3020
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Provider Business Mailing Address
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Address Line | 9301 HIGHWAY 178 S
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City | SALUDA
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State | SC
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Zip | 29138-9522
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Country | US
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Telephone | 864-310-9500
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Fax | 864-719-3020
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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