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General NPI Number Information
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NPI Number | 1578505228
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Entity Type | Organization
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Legal Business Name | MARTIN MEMORIAL PHYSICIAN CORPORATION INC
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Dates
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Enumeration Date | 06/10/2006
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Last Update Date | 08/08/2025
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Provider Practice Location Address
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Address Line | 200 SE HOSPITAL AVE
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City | STUART
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State | FL
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Zip | 34994-2346
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Country | US
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Telephone | 772-223-2832
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Fax | 772-781-2716
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Provider Business Mailing Address
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Address Line | 6801 BRECKSVILLE RD STE 20 ATTN: DPC RK2-7
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City | INDEPENDENCE
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State | OH
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Zip | 44131-5062
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Country | US
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Telephone | 216-636-4969
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Fax | 216-636-6063
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Authorized Official
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Title or Position | EXECUTIVE VP CHIEF FINANCE OFFICER
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Name | DENNIS LARAWAY
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Credential |
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Telephone | 216-445-1343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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