1144333055 NPI number — DR. THOMAS E MARTENS DO

Table of content: DR. THOMAS E MARTENS DO (NPI 1144333055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144333055 NPI number — DR. THOMAS E MARTENS DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MARTENS
Provider First Name:
THOMAS
Provider Middle Name:
E
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1144333055
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/16/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18817 N HEATHERWILDE BLVD STE 150
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PFLUGERVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78660-1750
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-523-4878
Provider Business Mailing Address Fax Number:
512-870-9770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18817 HEATHERWILDE BLVD
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660-7866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-523-4878
Provider Business Practice Location Address Fax Number:
512-870-9770
Provider Enumeration Date:
08/16/2006

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: 207QA0505X , with the licence number:  L8125 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8U7931 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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