MEDICARE: EDWARD J MARTIN JR.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number	:	1518276864
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD J MARTIN JR.

Provider Business Mailing Address
First Line	:	509 E ELM ST
Second Line	:
City	:	SALINA
State	:	KS
Zip	:	67401-2353
Country	:	US
Telephone Number	:	785-825-0541
Fax Number	:	785-825-0062

Provider Business Practice Location Address
First Line	:	1508 MAIN ST
Second Line	:
City	:	GREAT BEND
State	:	KS
Zip	:	67530-4007
Country	:	US
Telephone Number	:	785-825-0541
Fax Number	:	785-825-0062

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

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	05/31/2026

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