MR. KEVIN RICHARD MATTOS (NPI# 1558576702) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558576702 |
| Entity Type | Individual |
| Full Name | MR. KEVIN RICHARD MATTOS |
| Credential | IDC |
| Practice Address |
Marvin Shields Blvd Cbc Gulfport Gulfport MS 39501-0000 |
| Mailing Address |
4674 Cerny Rd Pensacola FL 32526-2753 |
| Practice Telephone | 8503410754 |
| Practice Fax Number | 2288712135 |
| Mailing Telephone | 8503410754 |
| Mailing Fax Number | 2288712135 |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2007-07-08 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1710I1002X |
Military Health Care Provider Specialization: Independent Duty Corpsman |
Other Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1215403787 | Kevin Len Mattos | Case Manager/Care Coordinator | 530 Kings County Dr Ste 104, Hanford, CA 93230-5954 | 2018-10-22 |
| Street Address |
MARVIN SHIELDS BLVD CBC GULFPORT |
| City | GULFPORT |
| State | MS |
| Zip Code | 39501-0000 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1730721374 | Affinity Healthcare LLC | Non-emergency Medical Transport (VAN) | 1822 15th St, Suite 8, Gulfport, MS 39501 | 2019-10-15 |
| 1093361156 | Gulf Coast Companion Care, LLC | Home Health | 1314 Pass Road, Ste B, Gulfport, MS 39501 | 2019-08-14 |
| 1609420991 | Greg Meekin Ent | Otolaryngology | 1201 31st Avenue, Gulfport, MS 39501 | 2019-07-25 |
| 1225681216 | Murphy Chiropractic Gulfport, LLC | Clinic/Center | 2700 25th Ave., Gulfport, MS 39501 | 2019-07-19 |
| 1477022838 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 1110 Broad Street, Suite 300, Gulfport, MS 39501 | 2018-11-15 |
| 1477003028 | Mindful Matters | Nurse Practitioner | 1613 23rd Avenue, Gulfport, MS 39501 | 2016-10-06 |
| 1902294093 | Tangular Barnes | Nurse Practitioner | Gulf Coast Mental Health Center, 1600 Broad Ave, Gulfport, MS 39501 | 2014-12-25 |
| 1487065355 | Huong Nguyen | Pharmacist | 2433 25th Avenue, Gulfport, MS 39501 | 2014-05-14 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| Find all providers in zip 39501 | ||||
| Taxonomy Code | 1710I1002X |
| Grouping | Other Service Providers |
| Classification | Military Health Care Provider |
| Specialization | Independent Duty Corpsman |
| A Navy Independent Duty Corpsman (IDC) is an active duty Sailor who has successfully completed one of the Navy's specific IDC training programs. IDCs are formally trained and educated to perform primary medical care and minor surgical services in a variety of health care and non-health care settings worldwide under indirect physician supervision. IDCs provide care to Department of Defense operational forces and other supporting forces such as contractors and foreign nationals. |
| Notes: Source: Bureau of Medicine and Surgery, Department of the Navy [7/1/2005: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1528515046 | Nicolas Riley | Military Health Care Provider | 5501 Marvin Shields Blvd., Gulfport, MS 39501-5007 | 2016-09-01 |
| 1477932200 | Michael Alexander Boartfield | Military Health Care Provider | 4033a Mallard Cv, Gulfport, MS 39501-2833 | 2015-05-26 |
| 1336536531 | Jeffrey Alexander Leemauk | Military Health Care Provider | 4010a Blue Heron Way, Gulfport, MS 39501-2815 | 2015-04-25 |
| 1770907412 | Matthew Coleman | Military Health Care Provider | Nbhc Naval Construction Battalion Center Gulfport, 5501 Marvin Shields Blvd, Gulfport, MS 39501 | 2014-02-18 |
| 1427316041 | Jeremiah John Baldwin | Military Health Care Provider | 5303 Marvin Shields Blvd, Gulfport, MS 39501-9013 | 2012-05-02 |
| 1245563162 | Jenesia Arielle Dillow Ordonia | Military Health Care Provider | 3158b Holloway Dr, Gulfport, MS 39501-9030 | 2009-09-10 |
| 1326298795 | Greg Allan Lassiter | Military Health Care Provider | 3110 B Seagull St, Gulfport, MS 39501 | 2008-09-23 |
| 1124203187 | James Sheldon Burnett | Military Health Care Provider | Nmcb 74, Unit 60243, Gulfport, MS 34099 | 2008-01-08 |
| 1104006246 | Jeremy Louis Stover | Military Health Care Provider | 55101 Marvin Shields Blvd, Gulfport, MS 39501 | 2007-11-06 |
| 1184830580 | Sheila Lee Shipman | Military Health Care Provider | Nmcb Seven, Unit 60252, Gulfport, MS 34099-5061 | 2007-05-15 |
| Find all providers in GULFPORT | ||||
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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.