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General NPI Number Information
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NPI Number | 1558616730
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Entity Type | Organization
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Legal Business Name | MARTIN CENTER, INC.
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 3549 N COLLEGE AVE 3545 NORTH COLLEGE AVENUE
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-3733
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Country | US
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Telephone | 317-927-5158
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Fax | 317-927-5167
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Provider Business Mailing Address
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Address Line | 3549 N COLLEGE AVE 3545 NORTH COLLEGE AVENUE
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City | INDIANAPOLIS
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State | IN
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Zip | 46205-3733
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Country | US
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Telephone | 317-927-5158
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Fax | 317-927-5167
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Authorized Official
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Title or Position | MEDICAL
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Name | DR. RAYMOND PIERCE
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Credential | M.D.
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Telephone | 317-414-2215
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State | IN
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