MEDICARE: GEORGE N MARTIN RPH, EMT-I

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	146M00000X	Intermediate Emergency Medical Technician	31094	TX
2	183500000X	Pharmacist	17533	TX

General Provider Information

NPI Number	:	1558498071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GEORGE N MARTIN RPH, EMT-I

Provider Business Mailing Address
First Line	:	3190 PITTMAN RD
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-3602
Country	:	US
Telephone Number	:	210-667-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 PITTMAN RD
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-3602
Country	:	US
Telephone Number	:	210-667-1001
Fax Number	:

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	10/12/2007

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