Provider Demographics
NPI:1285950063
Name:CRAIG M. MATHERNE, M.D., A.P.M.C.
Entity type:Organization
Organization Name:CRAIG M. MATHERNE, M.D., A.P.M.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:MATHERNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:337-457-8040
Mailing Address - Street 1:3521 HIGHWAY 190
Mailing Address - Street 2:SUITE P
Mailing Address - City:EUNICE
Mailing Address - State:LA
Mailing Address - Zip Code:70535-5135
Mailing Address - Country:US
Mailing Address - Phone:337-457-8040
Mailing Address - Fax:337-457-8043
Practice Address - Street 1:3521 HIGHWAY 190
Practice Address - Street 2:SUITE P
Practice Address - City:EUNICE
Practice Address - State:LA
Practice Address - Zip Code:70535-5135
Practice Address - Country:US
Practice Address - Phone:337-457-8040
Practice Address - Fax:337-457-8043
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-19
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA13221R173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes173000000XOther Service ProvidersLegal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1558729Medicaid
LADR4154OtherMEDICARE ID TYPE UNSPECIFIED
LA5E772Medicare PIN
LAH01255Medicare UPIN