Provider Demographics
NPI:1447352786
Name:MATHEW M. JOSE, M.D., INC
Entity type:Organization
Organization Name:MATHEW M. JOSE, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MATHEW
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-738-3317
Mailing Address - Street 1:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:WAPAKONETA
Mailing Address - State:OH
Mailing Address - Zip Code:45895-0039
Mailing Address - Country:US
Mailing Address - Phone:419-738-3317
Mailing Address - Fax:419-738-5952
Practice Address - Street 1:1015 S BLACKHOOF ST
Practice Address - Street 2:
Practice Address - City:WAPAKONETA
Practice Address - State:OH
Practice Address - Zip Code:45895-2209
Practice Address - Country:US
Practice Address - Phone:419-738-3317
Practice Address - Fax:419-738-5952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-05
Last Update Date:2011-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35072597J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDN5206OtherRAILROAD MEDICARE GROUP PTAN
OH2834893Medicaid
OHG73925Medicare UPIN
OH9372371Medicare PIN