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Organization
MATTAX NEU PRATER SURGERY CENTER, LLC
Active
Organization
MATTAX NEU PRATER SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES B. MATTAX JR. MD (PRESIDENT)
(417) 886-3937
Entity
Organization
Contact information
Practice address
1265 E PRIMROSE ST, SPRINGFIELD, MO 65804-4278
(417) 886-3937
(417) 886-1285
Mailing address
1265 E PRIMROSE ST, SPRINGFIELD, MO 65804-4278
(417) 886-3937
(417) 886-1285
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
94-7
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
503156903
—
MO
Enumeration date
03/27/2006
Last updated
05/05/2016
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