Healthcare Provider Details

I. General information

NPI: 1831484575
Provider Name (Legal Business Name): RYAN MARTIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2011
Last Update Date: 06/10/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5959 SHALLOWFORD RD SUITE 443, PAYER RELATIONS DEPARTMENT
CHATTANOOGA TN
37421-2285
US

IV. Provider business mailing address

8313 KNIGHT RD
HOUSTON TX
77054-3905
US

V. Phone/Fax

Practice location:
  • Phone: 423-756-2268
  • Fax: 423-266-9690
Mailing address:
  • Phone: 713-791-9080
  • Fax: 713-791-9084

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: