Provider Demographics
NPI:1407421258
Name:MARTIN BIONICS CLINICAL CARE FT MYERS LLC
Entity Type:Organization
Organization Name:MARTIN BIONICS CLINICAL CARE FT MYERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CREIGHTON
Authorized Official - Middle Name:
Authorized Official - Last Name:UYECHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:844-624-6642
Mailing Address - Street 1:214 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4221
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12670 NEW BRITTANY BLVD STE 102
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3650
Practice Address - Country:US
Practice Address - Phone:844-624-6642
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier