MEDICARE: MATTHEWS-VU MEDICAL GROUP, P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	101Y00000X	Counselor
2	2084P0804X	Child & Adolescent Psychiatry Physician
3	208000000X	Pediatrics Physician

General Provider Information

NPI Number	:	1861026809
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MATTHEWS-VU MEDICAL GROUP, P.C.

Provider Business Mailing Address
First Line	:	4190 E WOODMEN RD STE 100
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8075
Country	:	US
Telephone Number	:	719-632-4455
Fax Number	:

Provider Business Practice Location Address
First Line	:	4150 E. WOODMEN RD.
Second Line	:	SUITE 100
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-8042
Country	:	US
Telephone Number	:	719-418-2121
Fax Number	:	719-633-4613

Authorized Official
Title or Position	:	CREDENTIAING
Name	:	KATE BOGUE
Credential	:
Telephone Number	:	719-632-4455

Provider Enumeration Date	:	02/28/2020
Last Update Date	:	10/26/2020

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