MEDICARE: MRS. MARTHA KAY DEMING RN, MSN,CNM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367A00000X	Advanced Practice Midwife	233995	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	87N757	OTHER	TX	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467479170
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARTHA KAY DEMING RN, MSN,CNM

Provider Business Mailing Address
First Line	:	3571 COUNTY ROAD NE 2110
Second Line	:
City	:	TALCO
State	:	TX
Zip	:	75487-4835
Country	:	US
Telephone Number	:	903-379-3283
Fax Number	:	903-572-0696

Provider Business Practice Location Address
First Line	:	106 2ND ST NW
Second Line	:
City	:	BOGATA
State	:	TX
Zip	:	75417-2451
Country	:	US
Telephone Number	:	903-632-0078
Fax Number	:	903-632-1825

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	01/09/2019

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