Provider Demographics
NPI:1053525063
Name:MELINDA M. MARTIN, M.D., P.L.L.C.
Entity type:Organization
Organization Name:MELINDA M. MARTIN, M.D., P.L.L.C.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER OF PRACTICE
Authorized Official - Prefix:MS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-777-0070
Mailing Address - Street 1:907 AINSWORTH DRIVE
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1607
Mailing Address - Country:US
Mailing Address - Phone:928-777-0070
Mailing Address - Fax:928-445-7163
Practice Address - Street 1:907 AINSWORTH DRIVE
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1607
Practice Address - Country:US
Practice Address - Phone:928-777-0070
Practice Address - Fax:928-445-7163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2014-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21893207VG0400X, 207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Single Specialty
No207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ151259Medicaid
AZ151259001Medicaid
AZF71223Medicare UPIN
Z132937Medicare PIN