MEDICARE: DR. GEORGE MATTHEW VAIL M.D.

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	207RI0200X	Infectious Disease Physician	01044013A	IN

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01170536	OTHER	IN	RR MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760650386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE MATTHEW VAIL M.D.

Provider Business Mailing Address
First Line	:	1100 REID PARKWAY
Second Line	:	MEDICAL STAFF SERIVCES
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-935-8802
Fax Number	:	765-983-3219

Provider Business Practice Location Address
First Line	:	1050 REID PKWY STE 205
Second Line	:
City	:	RICHMOND
State	:	IN
Zip	:	47374-1159
Country	:	US
Telephone Number	:	765-935-8928
Fax Number	:	765-935-8929

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

Provider Enumeration Date	:	02/16/2008
Last Update Date	:	05/19/2021

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