Provider Demographics
NPI:1154190957
Name:MAT ENTERPRISES LLC
Entity type:Organization
Organization Name:MAT ENTERPRISES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:DESHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-826-4151
Mailing Address - Street 1:140 NORTHSTAR DR
Mailing Address - Street 2:
Mailing Address - City:HOLTS SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:65043-1123
Mailing Address - Country:US
Mailing Address - Phone:573-826-4151
Mailing Address - Fax:
Practice Address - Street 1:140 NORTHSTAR DR
Practice Address - Street 2:
Practice Address - City:HOLTS SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:65043-1123
Practice Address - Country:US
Practice Address - Phone:573-826-4151
Practice Address - Fax:573-826-4153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy