Provider Demographics
NPI:1710384995
Name:VAUGHN MARTER, INC.
Entity type:Organization
Organization Name:VAUGHN MARTER, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:ROD
Authorized Official - Last Name:MARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:901-753-7520
Mailing Address - Street 1:1779 KIRBY PKWY
Mailing Address - Street 2:STE. 5A
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3666
Mailing Address - Country:US
Mailing Address - Phone:901-753-7520
Mailing Address - Fax:901-755-6432
Practice Address - Street 1:1779 KIRBY PKWY
Practice Address - Street 2:STE. 5A
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3666
Practice Address - Country:US
Practice Address - Phone:901-753-7520
Practice Address - Fax:901-755-6432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-03
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNL000000013928253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNH445444Medicaid