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General NPI Number Information
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NPI Number | 1811107337
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Entity Type | Organization
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Legal Business Name | MEDICAL MARTS,LLC
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1018 WASHINGTON BLVD
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City | OGDEN
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State | UT
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Zip | 84404-4949
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Country | US
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Telephone | 801-392-7100
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Fax |
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Provider Business Mailing Address
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Address Line | 2685 S RAINBOW BLVD SUITE 112
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City | LAS VEGAS
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State | NV
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Zip | 89146-5182
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Country | US
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Telephone | 702-562-0458
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Fax | 847-256-1951
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Authorized Official
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Title or Position | DIRECTOR OF PAYER RELATIONS
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Name | MR. PAUL MATHEWSON
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Credential |
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Telephone | 702-562-0458
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number | 6571785-8019
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License Number State | UT
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