Provider Demographics
NPI:1033404272
Name:MARTINA AUDIOLOGY AND HEARING SERVICES, LLC
Entity Type:Organization
Organization Name:MARTINA AUDIOLOGY AND HEARING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:239-433-2060
Mailing Address - Street 1:15271 MCGREGOR BLVD
Mailing Address - Street 2:SUITE 17
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1908
Mailing Address - Country:US
Mailing Address - Phone:239-433-2060
Mailing Address - Fax:239-433-0925
Practice Address - Street 1:15271 MCGREGOR BLVD
Practice Address - Street 2:SUITE 17
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-1908
Practice Address - Country:US
Practice Address - Phone:239-433-2060
Practice Address - Fax:239-433-0925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAY103261QH0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0700XAmbulatory Health Care FacilitiesClinic/CenterHearing and Speech