Provider Demographics
NPI:1003447764
Name:MARTIN BIONICS CLINICAL CARE DALLAS, LLC
Entity Type:Organization
Organization Name:MARTIN BIONICS CLINICAL CARE DALLAS, LLC
Other - Org Name:MARTIN BIONICS CLINICAL CARE DALLAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:SETH
Authorized Official - Middle Name:
Authorized Official - Last Name:REITER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-624-6642
Mailing Address - Street 1:214 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4221
Mailing Address - Country:US
Mailing Address - Phone:844-624-6642
Mailing Address - Fax:
Practice Address - Street 1:850 W JOHN CARPENTER FWY
Practice Address - Street 2:
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75039-2303
Practice Address - Country:US
Practice Address - Phone:844-624-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CAPITAL PROSTHETICS & ORTHOTICS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-01-31
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
No224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Single Specialty