MEDICARE: JERMAINE ORLANDO MATTHEW LPN

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	343900000X	Non-emergency Medical Transport (VAN)
2	164W00000X	Licensed Practical Nurse	2007012721	MO

General Provider Information

NPI Number	:	1427257997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERMAINE ORLANDO MATTHEW LPN

Provider Business Mailing Address
First Line	:	4700 N HILLS LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-1030
Country	:	US
Telephone Number	:	314-591-8801
Fax Number	:

Provider Business Practice Location Address
First Line	:	4700 N HILLS LN
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63121-1030
Country	:	US
Telephone Number	:	314-591-8801
Fax Number	:

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

Provider Enumeration Date	:	07/16/2007
Last Update Date	:	12/06/2023

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