Basic Information
| Provider Information | |||||||||
| NPI: | 1689623662 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARTHA J. HERRING, MD PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4700 FORUM BLVD | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652035654 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734494936 | ||||||||
| FaxNumber: | 5734496795 | ||||||||
| Practice Location | |||||||||
| Address1: | 1605 E BROADWAY | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | COLUMBIA | ||||||||
| State: | MO | ||||||||
| PostalCode: | 652018023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5738158120 | ||||||||
| FaxNumber: | 5734498183 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 10/23/2007 | ||||||||
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| AuthorizedOfficialLastName: | HERRING | ||||||||
| AuthorizedOfficialFirstName: | MARTHA | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 5738158120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 199366 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | DE6831 | 01 | MO | RAILROAD MEDICARE | OTHER | 5000093505 | 05 | MO | MEDICAID | 720350 | 01 | MO | HEALTHLINK PROVIDER NUMBE | OTHER | G32075 | 01 | MO | MERCY | OTHER |