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NPI Code Detail

MEDICARE: MARTINS FOODS OF SOUTH BURLINGTON LLC

MEDICARE: MARTINS FOODS OF SOUTH BURLINGTON LLC
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
1332B00000XDurable Medical Equipment & Medical Supplies
23336C0003XCommunity/Retail Pharmacy022002NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22063154OTHERPK

General Provider Information

NPI Number : 1679681050
Entity Type Code : Organization
Provider Name (Legal Business Name) : MARTINS FOODS OF SOUTH BURLINGTON LLC
Provider Business Mailing Address
First Line : PO BOX 1000
Second Line : MS 3000
City : PORTLAND
State : ME
Zip : 04104-5005
Country : US
Telephone Number : 207-885-7454
Fax Number : 704-645-6531
Provider Business Practice Location Address
First Line : 1400 ALTAMONT AVE
Second Line :
City : SCHENECTADY
State : NY
Zip : 12303-2909
Country : US
Telephone Number : 518-357-2054
Fax Number : 518-357-0152
Authorized Official
Title or Position : PRESIDENT AND MANAGER
Name : MICHAEL VAIL
Credential :
Telephone Number : 207-885-7454
Provider Enumeration Date : 08/27/2006
Last Update Date : 09/19/2025

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