MEDICARE: MATTHEW PEARCE

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1255705927
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW PEARCE

Provider Business Mailing Address
First Line	:	1411 PALMAR ST
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5317
Country	:	US
Telephone Number	:	318-436-6599
Fax Number	:

Provider Business Practice Location Address
First Line	:	1411 PALMAR ST
Second Line	:
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-5317
Country	:	US
Telephone Number	:	318-436-6599
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/18/2015
Last Update Date	:	09/04/2020

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Directions to “ MATTHEW PEARCE ” Practice Location

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