Provider Demographics
NPI:1366969933
Name:HEARNE, MATTHEW LEWIS
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:LEWIS
Last Name:HEARNE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7504 S COUNTRY CLUB DR APT 105
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-5102
Mailing Address - Country:US
Mailing Address - Phone:405-476-2207
Mailing Address - Fax:
Practice Address - Street 1:7504 S COUNTRY CLUB DR
Practice Address - Street 2:APT 105
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159
Practice Address - Country:US
Practice Address - Phone:405-476-2207
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator