NPI Record of MATRIX CENTER (ADDICTIVE BEHAVIORAL CHANGE HEALTH GROUP) NPI 1003043639

Clinic/Center (Rehabilitation, Substance Use Disorder) in Wichita, KS

Complete NPI Record

Field Name Value Definition
NPI1003043639The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Entity Type Code2Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Employer Identification Number EINUNAVAILThe Employer Identification Number (EIN), assigned by the IRS, of the provider being identified.
Provider Organization Name Legal Business NameADDICTIVE BEHAVIORAL CHANGE HEALTH GROUPThe name of the organization provider. If the provider is an organization, this is the legal business name.
Provider Other Organization NameMATRIX CENTEROther name by which the organization provider is or has been known.
Provider Other Organization Name Type Code3Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
Provider First Line Business Mailing Address9918 E HARRY STThe first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Provider Business Mailing Address City NameWICHITAThe city name in the mailing address of the provider being identified.
Provider Business Mailing Address State NameKSThe State or Province name in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address State name’’.
Provider Business Mailing Address Postal Code672075008The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as ‘‘Provider location address postal code’’.
Provider Business Mailing Address Country Code If outside U S USThe country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number3167652764The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider Business Mailing Address Fax Number3166898285The fax number associated with the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address fax number’’.
Provider First Line Business Practice Location Address9918 E HARRY STThe first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City NameWICHITAThe city name in the location address of the provider being identified.
Provider Business Practice Location Address State NameKSThe State code in the location of the provider being identified.
Provider Business Practice Location Address Postal Code672075008The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Practice Location Address Country Code If outside U S USThe country code in the location address of the provider being identified.
Provider Business Practice Location Address Telephone Number3167652764The telephone number associated with the location address of the provider being identified.
Provider Business Practice Location Address Fax Number3166898285The fax number associated with the location address of the provider being identified.
Provider Enumeration Date6/22/2009The date the provider was assigned a unique identifier (assigned an NPI).
Last Update Date6/22/2009The date that a record was last updated or changed.
Authorized Official Last NameKAMAUThe last name of the person authorized to submit the NPI application or to change NPS data for a health care provider.
Authorized Official First NameSTEVEThe first name of the authorized official.
Authorized Official Middle NameGOKOThe middle name of the authorized official.
Authorized Official Title or PositionCEOThe title or position of the authorized official.
Authorized Official Telephone Number3167652764The 10-position telephone number of the authorized official.
Healthcare Provider Taxonomy Code 1261QR0405XCode designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Provider License Number 107080895The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider License Number State Code 1KSThe code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Primary Taxonomy Switch 1Y
Is Organization SubpartN
Authorized Official Name Prefix TextMR.
Authorized Official Credential TextB.A,CADC1