Provider Demographics
NPI:1447475983
Name:ST MATTHEWS NEUROLOGY PSC
Entity type:Organization
Organization Name:ST MATTHEWS NEUROLOGY PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:MELTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-899-1193
Mailing Address - Street 1:134 TRAVOIS RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-1673
Mailing Address - Country:US
Mailing Address - Phone:502-899-1193
Mailing Address - Fax:502-897-7233
Practice Address - Street 1:1850 STATE ST
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4990
Practice Address - Country:US
Practice Address - Phone:502-899-1193
Practice Address - Fax:502-897-7233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-17
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265022084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1157158OtherPASSPORT
KY000000187098OtherANTHEM
KY65936692Medicaid
KY6447Medicare PIN
KY000000187098OtherANTHEM