Healthcare Provider Details

I. General information

NPI: 1326088634
Provider Name (Legal Business Name): THOMAS MARTIN RN, CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2006
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 JOSEPH E. SANKER BOULEVARD
CINCINNATI OH
45212
US

IV. Provider business mailing address

4549 RAYNOR COURT
MASON OH
45040
US

V. Phone/Fax

Practice location:
  • Phone: 513-204-5696
  • Fax: 877-284-4283
Mailing address:
  • Phone: 513-204-5696
  • Fax: 877-284-4283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number117984
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberNA029000
License Number StateOH
# 3
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number029000
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: