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Kenneth L. Mattox

Thoracic Surgery (Cardiothoracic Vascular Surgery)

Allopathic & Osteopathic Physicians

PECOS Enrollment

This provider is enrolled in PECOS as KENNETH MATTOX.

Based on the most recent information from CMS, provider Kenneth L. Mattox is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1447349816
Provider Type
Individual
Full Name
Mattox, Kenneth L.
Credential
MD

Gender
Male
Sole Proprietor
No
Enumeration Date
10/12/2006
Last Updated
4/11/2011

Contact Information

Practice Location

1504 Taub Loop, Houston, TX 77030-1608

(713) 873-8890

(713) 873-8898

Mailing Location

2 Greenway Plz, Suite 910, Houston, TX 77046-0297

(713) 798-1750

(713) 798-1144

Provider Taxonomies

Code	Description	License
Code 208G00000X Primary	Description Thoracic Surgery (Cardiothoracic Vascular Surgery) Allopathic & Osteopathic Physicians	License D1724 Texas

Provider Identifiers

ID	Description	Issuer
ID 115298501	Description Medicaid	Issuer Unlisted Texas

Kenneth L. Mattox

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

Park, Han Ki

Elsenousi, Abdussalam Elsenousi

Suarez, Erik Eddie

Orozco -Sevilla, Vicente

Shafii, Alexis Edward

Sarfaraz, Ziyab

Pajaro, Octavio Enrique

Ghanta, Ravi K.

Spicer, Jonathan

Horne, David