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General NPI Number Information
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NPI Number | 1730190836
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Entity Type | Individual
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Provider Name | MATTHEW R MACHA MD
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Gender | Male
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Dates
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Enumeration Date | 08/11/2006
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 323 E RIVERSIDE DR STE 220
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City | EAGLE
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State | ID
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Zip | 83616-5246
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Country | US
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Telephone | 208-343-5600
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Fax | 208-779-2898
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Provider Business Mailing Address
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Address Line | PO BOX 2045
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City | EAGLE
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State | ID
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Zip | 83616-9110
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Country | US
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Telephone | 208-343-5600
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Fax | 208-779-2898
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | M6834
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License Number State | ID
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