1871077511 NPI number — JANET REEVES MARTIN APRN

Table of content: DEMARIUS RAYFORD LOTT (NPI 1215742705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871077511 NPI number — JANET REEVES MARTIN APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JANET
Provider Middle Name:
REEVES
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MARTIN
Provider Other First Name:
JANET
Provider Other Middle Name:
LEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1871077511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
130 PAVILLON DR.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEWPORT, KY
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
41071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-652-7203
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
INFINITY DIALYSIS
Provider Second Line Business Practice Location Address:
4750 EAST GALBRAITH RD. SUITE 103
Provider Business Practice Location Address City Name:
CINCINNATI
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
41017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-984-3500
Provider Business Practice Location Address Fax Number:
513-791-2151
Provider Enumeration Date:
09/19/2018

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: 363LF0000X , with the licence number:  3012567 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 3012567 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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