Provider Demographics
NPI:1518543172
Name:THOMAS E MARTENS DO PA
Entity Type:Organization
Organization Name:THOMAS E MARTENS DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-523-4878
Mailing Address - Street 1:18817 N HEATHERWILDE BLVD STE 150
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-1750
Mailing Address - Country:US
Mailing Address - Phone:512-523-4878
Mailing Address - Fax:512-870-9770
Practice Address - Street 1:11403 OCONNOR RD STE 118
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-5391
Practice Address - Country:US
Practice Address - Phone:210-910-4949
Practice Address - Fax:512-870-9770
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THOMAS E MARTENS DO PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-03-23
Last Update Date:2021-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty