MEDICARE: MATTICKS MEDCON LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1457392227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTICKS MEDCON LLC

Provider Business Mailing Address
First Line	:	6309 WIND TREE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-3738
Country	:	US
Telephone Number	:	217-899-7524
Fax Number	:	217-529-9514

Provider Business Practice Location Address
First Line	:	6309 WIND TREE RD
Second Line	:
City	:	SPRINGFIELD
State	:	IL
Zip	:	62712-3738
Country	:	US
Telephone Number	:	217-899-7524
Fax Number	:	217-529-9514

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. MARIA MATTICKS
Credential	:
Telephone Number	:	217-899-7524

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/22/2020

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Directions to “MATTICKS MEDCON LLC ” Practice Location

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