Basic Information
| Provider Information | |||||||||
| NPI: | 1316014442 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARTIN MEDICAL INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 11009 | ||||||||
| Address2: | |||||||||
| City: | OLYMPIA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 985081009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603522037 | ||||||||
| FaxNumber: | 3603520637 | ||||||||
| Practice Location | |||||||||
| Address1: | 555 116TH AVE NE STE 126 | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980045233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3604255334 | ||||||||
| FaxNumber: | 3604625333 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/30/2006 | ||||||||
| LastUpdateDate: | 02/10/2009 | ||||||||
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| AuthorizedOfficialLastName: | MARTIN | ||||||||
| AuthorizedOfficialFirstName: | DONNA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4254625334 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | ARNP | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BC3200X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Customized Equipment |
ID Information
| ID | Type | State | Issuer | Description | 9037896 | 05 | WA | MEDICAID | MA9226 | 01 | WA | REGENCE RIDER # | OTHER | 0104981 | 01 | WA | L&I# | OTHER | 9037895 | 05 | WA | MEDICAID |