MEDICARE: ELIZABETH S. MATEOS-TIONGCO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207V00000X	Obstetrics & Gynecology Physician	01033055B	IN
2	207V00000X	Obstetrics & Gynecology Physician	01033055A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	160025634	OTHER	IN	RAILROAD MED
3	1790783637	OTHER	IN	COMMERICAL
4	000000084916	OTHER	IN	BCBS

General Provider Information

NPI Number	:	1093099012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ELIZABETH S. MATEOS-TIONGCO

Provider Business Mailing Address
First Line	:	PO BOX 236
Second Line	:
City	:	LYONS
State	:	IN
Zip	:	47443-0236
Country	:	US
Telephone Number	:	812-659-2030
Fax Number	:	812-659-7601

Provider Business Practice Location Address
First Line	:	195 E BROAD ST
Second Line	:
City	:	LYONS
State	:	IN
Zip	:	47443-9502
Country	:	US
Telephone Number	:	812-659-2030
Fax Number	:	812-659-7601

Authorized Official
Title or Position	:	OWNER
Name	:	DR. ELIZABETH SANCHEZ MATEOS
Credential	:	M.D.
Telephone Number	:	812-659-2030

Provider Enumeration Date	:	10/10/2011
Last Update Date	:	10/10/2011

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