MEDICARE: MATTHEW QUINN OLDEN R.T. (R),(T)

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	2471R0002X	Radiation Therapy Radiologic Technologist	19961	TX
2	2471R0002X	Radiation Therapy Radiologic Technologist	233121

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	19961	OTHER	TX	TEXAS DEPARTMENT OF HEALTH
2	233121	OTHER		AMERICAN REGISTRY RADIOLOGIC TECHNOLOGIST

General Provider Information

NPI Number	:	1497070379
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW QUINN OLDEN R.T. (R),(T)

Provider Business Mailing Address
First Line	:	4004 DORRIS RD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-4003
Country	:	US
Telephone Number	:	817-308-0268
Fax Number	:	972-258-7972

Provider Business Practice Location Address
First Line	:	4004 DORRIS RD
Second Line	:
City	:	IRVING
State	:	TX
Zip	:	75038-4003
Country	:	US
Telephone Number	:	817-308-0268
Fax Number	:	972-258-7972

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

Provider Enumeration Date	:	04/02/2010
Last Update Date	:	04/02/2010

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Directions to “ MATTHEW QUINN OLDEN R.T. (R),(T)” Practice Location

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