1003447764 NPI number — MARTIN BIONICS CLINICAL CARE DALLAS, LLC

Table of content: (NPI 1003447764)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003447764 NPI number — MARTIN BIONICS CLINICAL CARE DALLAS, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN BIONICS CLINICAL CARE DALLAS, LLC
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:
1003447764
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
214 E MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73104-4221
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
844-624-6642
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
850 W JOHN CARPENTER FWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75039-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-624-6642
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/31/2020

Additional Information

Authorized Official

Authorized Official Last Name:
BEARD
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALING COORDINATOR
Authorized Official Telephone Number:
405-900-4935

Provider Taxonomy Codes

  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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