Individual ProviderLucia Rivera MatosInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831(502) 629-5552(502) 588-9490PECOS EnrollmentBased on the most recent information from CMS, provider Lucia Rivera Matos is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records yesterday at 11:47 AM.Profile DetailsProvider ID1205331725Provider TypeIndividualFull NameRivera Matos, LuciaCredentialMDGenderFemaleSole ProprietorNoEnumeration Date3/27/2018Last Updated11/27/2024Contact InformationPractice LocationPractice Address200 E Chestnut St Bldg Suite303, Louisville, KY 40202-1831Phone(502) 629-5552Fax(502) 629-3132Mailing LocationMailing AddressPO Box 776351, Chicago, IL 60677-6351Phone(502) 588-9490Fax(502) 272-5116Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense56935KentuckyCode207RG0100XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense56935KentuckyCode207RT0003XDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense036156423IllinoisCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer