Provider Demographics
NPI:1023105731
Name:NEW ALBANY MEDICAL ASSOCIATES, LLC
Entity type:Organization
Organization Name:NEW ALBANY MEDICAL ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MATRE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:740-607-4328
Mailing Address - Street 1:153 W MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-9224
Mailing Address - Country:US
Mailing Address - Phone:614-939-9110
Mailing Address - Fax:614-939-4857
Practice Address - Street 1:153 W MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054-9224
Practice Address - Country:US
Practice Address - Phone:614-939-9110
Practice Address - Fax:614-939-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9366591Medicare PIN