Provider Demographics
NPI:1245794403
Name:MARY E MARTIN DIABETES CENTER OF EXCELLENCE, INC
Entity Type:Organization
Organization Name:MARY E MARTIN DIABETES CENTER OF EXCELLENCE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:K
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-435-7658
Mailing Address - Street 1:P.O. BOX 1528
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41702-1528
Mailing Address - Country:US
Mailing Address - Phone:606-435-7519
Mailing Address - Fax:606-435-7524
Practice Address - Street 1:101 TOWN AND COUNTRY LANE
Practice Address - Street 2:SUITE 105
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9524
Practice Address - Country:US
Practice Address - Phone:606-435-7681
Practice Address - Fax:606-435-7524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-22
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center