Provider Demographics
NPI:1073810354
Name:TOM MARTIN MD SC
Entity Type:Organization
Organization Name:TOM MARTIN MD SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD INTERNIST
Authorized Official - Prefix:
Authorized Official - First Name:TOM
Authorized Official - Middle Name:D
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-532-6330
Mailing Address - Street 1:1050 ML KING DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CENTRALIA
Mailing Address - State:IL
Mailing Address - Zip Code:62801-3060
Mailing Address - Country:US
Mailing Address - Phone:618-532-6330
Mailing Address - Fax:618-532-7227
Practice Address - Street 1:1050 ML KING DR
Practice Address - Street 2:SUITE 104
Practice Address - City:CENTRALIA
Practice Address - State:IL
Practice Address - Zip Code:62801-3060
Practice Address - Country:US
Practice Address - Phone:618-532-6330
Practice Address - Fax:618-532-7227
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-22
Last Update Date:2011-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty