| Organization Name: | MATRIX MEDICAL NETWORK |
| NPI Number: | 1003178849 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARLA RAE KYCHIK (NURSE PRACTITIONER) |
| Mailing Address: | 6815 Country Glen Ct Nw Albuquerque |
| State: | NM US |
| Postal Code: | 871144387 |
| Phone Number: | 5053314490 |
| Fax Number: | |
| NPI Enumeration Date: | 06/07/2012 |
| NPI Last Update Date: | 06/07/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 302R00000X |
| License Number: | CNP-01975 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Managed Care Organizations |
| Taxonomy Classification: | Health Maintenance Organization |
| Taxonomy Specialization: | |
| Taxonomy Definition: | (1) A form of health insurance in which its members prepay a premium for the HMO |