MEDICARE: MRS. TONYA LYNN MARTIN

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	171W00000X	Contractor	160021783	AR

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	:	1831364793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TONYA LYNN MARTIN

Provider Business Mailing Address
First Line	:	107 JANETTE ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-3717
Country	:	US
Telephone Number	:	501-318-5285
Fax Number	:	501-318-5285

Provider Business Practice Location Address
First Line	:	107 JANETTE ST
Second Line	:
City	:	HOT SPRINGS
State	:	AR
Zip	:	71901-3717
Country	:	US
Telephone Number	:	501-318-5285
Fax Number	:	501-318-5285

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

Provider Enumeration Date	:	04/22/2008
Last Update Date	:	04/22/2008

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