Provider Demographics
NPI:1619974581
Name:CIRCLE OF LIFE OBSTETRICS AND FAMILY CARE, PLLC
Entity Type:Organization
Organization Name:CIRCLE OF LIFE OBSTETRICS AND FAMILY CARE, PLLC
Other - Org Name:JOHN P MARTIN MD AND CATHERINE S MARTIN DO
Other - Org Type:Other Name
Authorized Official - Title/Position:DIRECTOR OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:EDGAR
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:BRANCH
Authorized Official - Suffix:
Authorized Official - Credentials:MHA
Authorized Official - Phone:314-723-3931
Mailing Address - Street 1:PO BOX 23736
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37202-3736
Mailing Address - Country:US
Mailing Address - Phone:423-569-3762
Mailing Address - Fax:423-569-4909
Practice Address - Street 1:189 ANDREW ST
Practice Address - Street 2:
Practice Address - City:ONEIDA
Practice Address - State:TN
Practice Address - Zip Code:37841-6296
Practice Address - Country:US
Practice Address - Phone:423-569-3762
Practice Address - Fax:423-569-4909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-07
Last Update Date:2024-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26733207Q00000X
261QR1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65933152Medicaid
TN3717532Medicaid
KY65933152Medicaid