1255762738 NPI number — MARTIN ADVANCED THERAPEUTICS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255762738 NPI number — MARTIN ADVANCED THERAPEUTICS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN ADVANCED THERAPEUTICS
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:
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:
1255762738
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/09/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 27340
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85061-7340
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-943-9200
Provider Business Mailing Address Fax Number:
602-216-3000

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
32531 N SCOTTSDALE RD
Provider Second Line Business Practice Location Address:
SUITE 105-225
Provider Business Practice Location Address City Name:
SCOTTSDALE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85266-1519
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-317-8283
Provider Business Practice Location Address Fax Number:
480-656-5913
Provider Enumeration Date:
12/09/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
JANET
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
602-317-8283

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  33615 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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