Provider Demographics
NPI:1053322834
Name:MEDICAL MARTS LLC
Entity type:Organization
Organization Name:MEDICAL MARTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PAYER CONTRACTING
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:GARRETT
Authorized Official - Last Name:MATHEWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-562-0458
Mailing Address - Street 1:2685 S RAINBOW BLVD
Mailing Address - Street 2:SUITE 112
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-5182
Mailing Address - Country:US
Mailing Address - Phone:702-562-0458
Mailing Address - Fax:702-562-9587
Practice Address - Street 1:2685 S RAINBOW BLVD
Practice Address - Street 2:SUITE 112
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-5182
Practice Address - Country:US
Practice Address - Phone:702-562-0458
Practice Address - Fax:702-562-9587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care