MEDICARE: ORTHO MART 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	332B00000X	Durable Medical Equipment & Medical Supplies		FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PENDING	OTHER	FL	PENDING MEDICARE

General Provider Information

NPI Number	:	1740570605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ORTHO MART INC

Provider Business Mailing Address
First Line	:	14025 SW 142ND AVE
Second Line	:	SUITE 19
City	:	MIAMI
State	:	FL
Zip	:	33186-6756
Country	:	US
Telephone Number	:	786-470-6655
Fax Number	:	305-378-0568

Provider Business Practice Location Address
First Line	:	14025 SW 142ND AVE
Second Line	:	SUITE 19
City	:	MIAMI
State	:	FL
Zip	:	33186-6756
Country	:	US
Telephone Number	:	786-470-6655
Fax Number	:	305-378-0568

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ROLANDO MARTINEZ
Credential	:
Telephone Number	:	786-470-6655

Provider Enumeration Date	:	04/13/2011
Last Update Date	:	05/03/2011

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Directions to “ORTHO MART INC ” Practice Location

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