MEDICARE: MR. STEVEN T MARTIN FNP

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	164W00000X	Licensed Practical Nurse	RN116514	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	4120365	OTHER	SD	BLUE CROSS

General Provider Information

NPI Number	:	1720022817
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. STEVEN T MARTIN FNP

Provider Business Mailing Address
First Line	:	PO BOX 202
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38101-0202
Country	:	US
Telephone Number	:	901-757-2345
Fax Number	:	901-757-9065

Provider Business Practice Location Address
First Line	:	2743 SUMMER OAKS DR
Second Line	:
City	:	BARTLETT
State	:	TN
Zip	:	38134-2858
Country	:	US
Telephone Number	:	901-371-0200
Fax Number	:	901-888-1146

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	07/08/2007

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