MATTHEW A STACK PA C NPI 1033108667

NPI Information

  • NPI: 1033108667
  • Provider Name: MATTHEW A STACK, PA C
  • Classification: Physician Assistant - 363A00000X
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 121 N PINE RIVER ST
    ITHACA, MI
    ZIP 48847
  • Phone: (989) 287-0662

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NPI Details

Matthew A Stack, PA C is a physician assistant in Ithaca, MI with 23 years of experience. The provider is a physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. Matthew A Stack, PA C NPI is 1033108667. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

121 N PINE RIVER ST
ITHACA, MI
ZIP 48847-039
Phone: (989) 287-0662

The NPI 1033108667 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 10/17/2005 and was last updated on 5/10/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1103T00000XPsychologist6301007939MICHIGANNo
2363A00000XPhysician Assistant2782ARIZONANo
3363AM0700XPhysician AssistantMedicalNo
4363A00000XPhysician Assistant5601003961MICHIGANYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1P00140431OTHERARIZONARAILROAD
20852900260OTHERMICHIGANBCBSM
3762246MEDICAIDARIZONA
450155318OTHERNEW MEXICOMEDICAID

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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