1669529327 NPI number — JAMES H MARTIN JR. M.D.

Table of content: JAMES H MARTIN JR. M.D. (NPI 1669529327)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669529327 NPI number — JAMES H MARTIN JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JAMES
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669529327
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
900 SAINT CHRISTOPHER DR
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
ASHLAND
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
41101-7090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
606-836-3770
Provider Business Mailing Address Fax Number:
866-838-3770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
900 SAINT CHRISTOPHER DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
ASHLAND
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
41101-7090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
606-836-3770
Provider Business Practice Location Address Fax Number:
866-838-3770
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  28331 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 64283310 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000042823 . This is a "ANTHEM BLUE ACCESS NUMBER" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 020045216 . This is a "MEDICARE RR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0866068 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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