1982639175 NPI number — JAMES A MARTIN MD

Table of content: JAMES A MARTIN MD (NPI 1982639175)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982639175 NPI number — JAMES A MARTIN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTIN
Provider First Name:
JAMES
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1982639175
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/03/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-3146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-206-8406
Provider Business Mailing Address Fax Number:
855-823-8132

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1710 GUNBARREL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHATTANOOGA
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37421-3127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
423-553-1220
Provider Business Practice Location Address Fax Number:
423-553-1231
Provider Enumeration Date:
07/12/2006

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: 2085R0202X , with the licence number:  24438 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 300107647 . This is a "RR MCARE-CI" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 009918800 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300107970 . This is a "RR MCARE-ADR" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 3146630 . This is a "PLAZA BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: 000867798 , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4017577 . This is a "ADR BC/BS OF TN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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