Provider Demographics
NPI:1396820437
Name:SALINE MED-PEDS GROUP, INC
Entity Type:Organization
Organization Name:SALINE MED-PEDS GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:A
Authorized Official - Last Name:MARTINDALE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-315-1222
Mailing Address - Street 1:105 MCNEIL ST
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72015-3345
Mailing Address - Country:US
Mailing Address - Phone:501-315-1222
Mailing Address - Fax:501-315-1222
Practice Address - Street 1:105 MCNEIL ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3345
Practice Address - Country:US
Practice Address - Phone:501-315-1222
Practice Address - Fax:501-315-1241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X, 208000000X, 208D00000X
ARC7310207R00000X, 208000000X
ARE5062208000000X
ARC2718208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR161473002Medicaid
AR161473002Medicaid