MR. MATTHEW MANUEL CARRILLO (NPI# 1356386288) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1356386288 |
| Entity Type | Individual |
| Full Name | MR. MATTHEW MANUEL CARRILLO |
| Credential | OWNER |
| Practice Address |
434 S 13th Ave Laurel MS 39440-4345 |
| Mailing Address |
Po Box 6501 Laurel MS 39441-6501 |
| Practice Telephone | 6016490001 |
| Practice Fax Number | 6016490035 |
| Mailing Telephone | 6016490001 |
| Mailing Fax Number | 6016490035 |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2007-11-07 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1744P3200X |
Specialist Specialization: Prosthetics Case Management |
07014/11.1 | MS | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 01339261 | 05 |
| Street Address |
434 S 13TH AVE |
| City | LAUREL |
| State | MS |
| Zip Code | 39440-4345 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1053593129 | Advanced Orthotics & Prosthetics Clinic | Durable Medical Equipment & Medical Supplies | 434 S 13th Ave, Laurel, MS 39440-4345 | 2007-11-30 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306323159 | Tender Loving Care Homecare LLC | Homemaker | 509 Central Ave Ste 224, Laurel, MS 39440 | 2018-07-24 |
| 1669837910 | Laurel Dental Properties | Dentist | 1925 Pine Belt Drive, Laurel, MS 39440 | 2015-12-30 |
| 1215282991 | South Central Regional Medical Center | Clinic/Center | 525 Wayne Drive, Laurel, MS 39440 | 2012-07-18 |
| 1568721215 | Terry Ratcliff Perkins | Counselor | 5192 Hwy 11 North, Laurel, MS 39440 | 2012-05-15 |
| 1437453057 | Alexander Milne Home for Women | Residential Treatment Facility, Mental Retardation and/or Developmental Disabilities | 616 East 19th Street, Laurel, MS 39440 | 2010-12-23 |
| 1710135629 | Jeffrey R. Moffett | Nurse Practitioner | 3115 Audubon Dr, Laurel, MS 39440 | 2008-09-04 |
| 1003096785 | Family Health Center, Inc | Obstetrics & Gynecology | 103 S. 12th Avenue, Laurel, MS 39440 | 2007-11-09 |
| 1669672143 | Laurel Urology Clinic Pa | Urology | 304 S 10th Ave, Laurel, MS 39440 | 2007-07-23 |
| 1093912370 | Tanweer Hussain Majid | Surgery | 1007 Jefferson Street, Laurel, MS 39440 | 2007-06-29 |
| 1780889923 | Hattiesburg Eye Clinic, Pa | Ophthalmology | 1431 North 10th St, Suite 1, Laurel, MS 39440 | 2007-06-18 |
| Find all providers in zip 39440 | ||||
| Taxonomy Code | 1744P3200X |
| Grouping | Other Service Providers |
| Classification | Specialist |
| Specialization | Prosthetics Case Management |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1437766482 | Natalyn Obey | Specialist | 10095 Washington Blvd N Ste 134, Laurel, MD 20723-1968 | 2020-09-24 |
| 1013528686 | Melissa Hammond | Specialist | 595 Main St Ste 235a, Laurel, MD 20707-4352 | 2020-08-16 |
| 1497373492 | Irene Marie Watkins | Specialist | 595 Main St Ste 235, Laurel, MD 20707-4352 | 2020-07-07 |
| 1467074849 | Martha Tanesha Hines | Specialist | 3407 Fort Meade Rd Ste 14, Laurel, MD 20724-2003 | 2020-05-08 |
| 1568993681 | Teresa Zimmerman | Specialist | 339 Main St, Laurel, MD 20707-4130 | 2017-03-21 |
| 1295287357 | David Randy Harris | Specialist | 14300 Cherry Lane Ct, Suite 213, Laurel, MD 20707-4958 | 2016-10-25 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932715216 | Stacy Michelle Reed | Specialist | 121 Lonnie Jenkins Dr, Pearl, MS 39208-3520 | 2020-09-22 |
| 1962014100 | Orthotic & Prosthetic Solutions LLC | Specialist | 3670 Lakeland Ln # B-4, Jackson, MS 39216-4700 | 2020-08-19 |
| 1023653714 | Aundray Terall Shackelford | Specialist | 105 Rankin Blvd Ext, Tupelo, MS 38801-4611 | 2019-11-17 |
| 1194383398 | Candice Williams | Specialist | 820 N Gloster St, Tupelo, MS 38804-1949 | 2019-06-03 |
| 1598252645 | Catiecha L Edwards | Specialist | 1162 Franklin St, Grenada, MS 38901-4237 | 2018-04-14 |
| 1992200950 | Cristy M Mathews | Specialist | 132 Paulding Rd, Leakesville, MS 39451-3073 | 2018-03-29 |
| 1386146520 | Jan A Jordan | Specialist | 1615 2nd Ave N, Columbus, MS 39701-4927 | 2018-03-04 |
| 1679085948 | Alan Evans | Specialist | 106 North Lafayette St, Starkville, MS 39759 | 2017-10-26 |
| 1649725409 | Tynita Steele | Specialist | 5304 Gautier Vancleave Rd, Gautier, MS 39553-4216 | 2016-08-22 |
| 1285097048 | The Lauren Forte Hair Loss Replacement Center | Specialist | 143 Laura Lake Rd, Vicksburg, MS 39180-9787 | 2016-03-30 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.