1659384006 NPI number — MOBIL MARTIN, INC.

Table of content: (NPI 1659384006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659384006 NPI number — MOBIL MARTIN, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOBIL MARTIN, INC.
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:
1659384006
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14837 DETROIT AVE
Provider Second Line Business Mailing Address:
BOX 123
Provider Business Mailing Address City Name:
LAKEWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44107-3909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
216-281-9300
Provider Business Mailing Address Fax Number:
216-281-8500

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1279 W 73RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44102-2060
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-281-9300
Provider Business Practice Location Address Fax Number:
216-281-8500
Provider Enumeration Date:
08/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VIRSIS
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
O
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
216-281-7777

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  180322 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 343800000X , with the licence number: 185815 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0856346 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2516405 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".