Provider Demographics
NPI:1679717581
Name:THOMAS E MARTENS DO PA
Entity type:Organization
Organization Name:THOMAS E MARTENS DO PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-523-5878
Mailing Address - Street 1:18817 N HEATHERWILDE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1750
Mailing Address - Country:US
Mailing Address - Phone:512-523-4878
Mailing Address - Fax:512-870-9770
Practice Address - Street 1:5920 W WILLIAM CANNON DR BLDG 6
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1902
Practice Address - Country:US
Practice Address - Phone:512-893-5750
Practice Address - Fax:512-870-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-22
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207QA0505X
TXL8125207QA0505X, 207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1687816-01Medicaid
TX1687816-01Medicaid
TX0022OZMedicare PIN