Healthcare Provider Details

I. General information

NPI: 1114942026
Provider Name (Legal Business Name): MARTIN MEDICAL SUPPLY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 11/26/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 SW 8TH ST SUITE 301
MIAMI FL
33144-4664
US

IV. Provider business mailing address

7105 SW 8TH ST SUITE 301
MIAMI FL
33144-4664
US

V. Phone/Fax

Practice location:
  • Phone: 305-264-4277
  • Fax: 305-264-4275
Mailing address:
  • Phone: 305-264-4277
  • Fax: 305-264-4275

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: LEONARDO ARTEAGA
Title or Position: PRESIDENT
Credential:
Phone: 305-264-4277