Provider Demographics
NPI:1568801967
Name:SAINT MARTIN MEDICAL CENTER PC
Entity Type:Organization
Organization Name:SAINT MARTIN MEDICAL CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CORAZON
Authorized Official - Middle Name:CARDENO
Authorized Official - Last Name:ESPELETA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-575-1079
Mailing Address - Street 1:1525 HUNT CLUB BLVD
Mailing Address - Street 2:SUITE 600-A
Mailing Address - City:GALLATIN
Mailing Address - State:TN
Mailing Address - Zip Code:37066-6070
Mailing Address - Country:US
Mailing Address - Phone:615-575-1079
Mailing Address - Fax:615-989-4185
Practice Address - Street 1:1525 HUNT CLUB BLVD
Practice Address - Street 2:SUITE 600-A
Practice Address - City:GALLATIN
Practice Address - State:TN
Practice Address - Zip Code:37066-6070
Practice Address - Country:US
Practice Address - Phone:615-575-1079
Practice Address - Fax:615-989-4185
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34085261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3857002Medicaid
TN3857007Medicaid
TNH23857OtherUPIN
TN3857007Medicaid
TN3857007Medicare PIN