MEDICARE: SALINE MED-PEDS GROUP, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	C7310	AR
2	207R00000X	Internal Medicine Physician
3	208000000X	Pediatrics Physician	E5062	AR
4	208000000X	Pediatrics Physician	C7310	AR
5	208D00000X	General Practice Physician	C2718	AR
6	208D00000X	General Practice Physician
7	208000000X	Pediatrics Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396820437
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SALINE MED-PEDS GROUP, INC

Provider Business Mailing Address
First Line	:	105 MCNEIL ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3345
Country	:	US
Telephone Number	:	501-315-1222
Fax Number	:	501-315-1222

Provider Business Practice Location Address
First Line	:	105 MCNEIL ST
Second Line	:
City	:	BENTON
State	:	AR
Zip	:	72015-3345
Country	:	US
Telephone Number	:	501-315-1222
Fax Number	:	501-315-1241

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MARK A MARTINDALE
Credential	:	M.D.
Telephone Number	:	501-315-1222

Provider Enumeration Date	:	10/26/2006
Last Update Date	:	04/28/2023

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Directions to “SALINE MED-PEDS GROUP, INC ” Practice Location

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