Provider Demographics
NPI:1295985992
Name:MARTIN FAMILY HEALTHCARE LLC.
Entity type:Organization
Organization Name:MARTIN FAMILY HEALTHCARE LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN ASST./OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:L
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:615-699-4035
Mailing Address - Street 1:P.O. BOX 425
Mailing Address - Street 2:
Mailing Address - City:RED BOILING SPRINGS
Mailing Address - State:TN
Mailing Address - Zip Code:37150
Mailing Address - Country:US
Mailing Address - Phone:615-699-4035
Mailing Address - Fax:615-699-4055
Practice Address - Street 1:120 MARKET ST.
Practice Address - Street 2:
Practice Address - City:RED BOILING SPRINGS
Practice Address - State:TN
Practice Address - Zip Code:37150
Practice Address - Country:US
Practice Address - Phone:615-699-4035
Practice Address - Fax:615-699-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-30
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPA0000001100363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty