Evans, Matthew Shane
Evans, Matthew Shane is an sole proprietor health care provider with primary practice located at 1705 Coffee Rd Suite 1, Modesto CA 95355-2809. He recently has 4 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist, Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pedorthist, Suppliers / Prosthetic/Orthotic Supplier. Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist is his primary health care specialty. Evans, Matthew Shane can be contacted via phone (209) 544-2273.Contact Information
Primary practice address
1705 Coffee Rd Suite 1
Modesto CA 95355-2809
Phone: (209) 544-2273
Fax: (209) 544-2274
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Prosthetist | 224P00000X | CPO02042 | California |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Orthotist | 222Z00000X | CPO02042 | California |
| Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Pedorthist | 224L00000X | CPO02042 | California |
| Suppliers / Prosthetic/Orthotic Supplier | 335E00000X | CPO02042 | California |
Profile Details
| NPI number | 1245476597 |
|---|---|
| LBN Legal business name | Evans, Matthew Shane |
| Credentials | CPO |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Dec 16th, 2008 |
| Last updated | May 22nd, 2014 - about 10 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1245476597 | NPPES |
| California | MEDICAID | XC0020420 |
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