Provider Demographics
NPI:1346772621
Name:MEDCARE MART, LLC
Entity Type:Organization
Organization Name:MEDCARE MART, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EHTESHAMUL
Authorized Official - Middle Name:
Authorized Official - Last Name:HAQUE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:706-649-7676
Mailing Address - Street 1:1501 13TH ST
Mailing Address - Street 2:SUITE M
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31901-2383
Mailing Address - Country:US
Mailing Address - Phone:706-649-7676
Mailing Address - Fax:706-649-5497
Practice Address - Street 1:1501 13TH ST
Practice Address - Street 2:SUITE M
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31901-2383
Practice Address - Country:US
Practice Address - Phone:706-649-7676
Practice Address - Fax:706-649-5497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-28
Last Update Date:2017-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5896400001Medicare NSC