1841270121 NPI number — KAREN A MARTIN

Table of content: (NPI 1841270121)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841270121 NPI number — KAREN A MARTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KAREN A MARTIN
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
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:
1841270121
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARTESIA
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88211-0012
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-746-1883
Provider Business Mailing Address Fax Number:
575-746-1885

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
611 W MAHONE DR STE D
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARTESIA
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88210-2075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-746-1883
Provider Business Practice Location Address Fax Number:
575-746-1885
Provider Enumeration Date:
01/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
575-746-1883

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 02406754007 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000Z6946 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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