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NPI Code Detail

MEDICARE: MATTHEWS-VU MEDICAL GROUP, P.C.

MEDICARE: MATTHEWS-VU MEDICAL GROUP, P.C.
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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1174102149
Entity Type Code : Organization
Provider Name (Legal Business Name) : MATTHEWS-VU MEDICAL GROUP, P.C.
Provider Business Mailing Address
First Line : 4190 E WOODMEN RD STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80920-8075
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1550 PULSAR DR STE 100
Second Line :
City : COLORADO SPRINGS
State : CO
Zip : 80916-4503
Country : US
Telephone Number : 719-632-4455
Fax Number :
Authorized Official
Title or Position : CREDENTIALING
Name : KATE BOGUE
Credential :
Telephone Number : 719-632-4455
Provider Enumeration Date : 04/06/2021
Last Update Date : 04/06/2021

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