MEDICARE: MRS. MARY LOUISE MARTIN EMT-I

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	146M00000X	Intermediate Emergency Medical Technician	36210	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	36210	OTHER	TX	TEXAS DEPARTMENT OF HEALTH SERVICES

General Provider Information

NPI Number	:	1477882132
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LOUISE MARTIN EMT-I

Provider Business Mailing Address
First Line	:	3190 PITTMAN RD
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-3602
Country	:	US
Telephone Number	:	210-667-1001
Fax Number	:

Provider Business Practice Location Address
First Line	:	3190 PITTMAN RD
Second Line	:
City	:	SAINT HEDWIG
State	:	TX
Zip	:	78152-3602
Country	:	US
Telephone Number	:	210-667-1001
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2009
Last Update Date	:	12/09/2009

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