Healthcare Provider Details

I. General information

NPI: 1447358312
Provider Name (Legal Business Name): MARTIN BROTHERS DISTRIBUTING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 VIKING RD
CEDAR FALLS IA
50613-6930
US

IV. Provider business mailing address

406 VIKING RD PO BOX 69
CEDAR FALLS IA
50613-6930
US

V. Phone/Fax

Practice location:
  • Phone: 319-266-1775
  • Fax: 319-266-8947
Mailing address:
  • Phone: 319-266-1775
  • Fax: 319-266-8947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. TIMOTHY R GLENN
Title or Position: PRESIDENT MED SUPPLIES
Credential:
Phone: 319-266-1775