Mathis, John Glenn
Mathis, John Glenn is an individual health care provider with primary practice located at 17501 Generations Dr , South Bend IN 46635-1589. He recently has only one registered license in Allopathic & Osteopathic Physicians / Gastroenterology, which is considered as his primary health care specialty. Mathis, John Glenn can be contacted via phone (574) 234-0049.Contact Information
Primary practice address
17501 Generations Dr
South Bend IN 46635-1589
Phone: (574) 234-0049
Fax: (574) 251-2861
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Gastroenterology | 207RG0100X | 01026543A | Indiana |
Profile Details
| NPI number | 1427051341 |
|---|---|
| LBN Legal business name | Mathis, John Glenn |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | May 24th, 2005 |
| Last updated | Oct 4th, 2010 - about 14 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 | 1427051341 | NPPES |
| Indiana | Other | 4359074 | AETNA |
| Indiana | Other | 000000084425 | AETNA |
| Indiana | MEDICAID | 100223380A | AETNA |
| Indiana | Other | 2010421004 | AETNA |
| Indiana | Other | 110082368 | AETNA |
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