Provider Demographics
NPI:1629625041
Name:MARTIN WOUND CARE LLC
Entity Type:Organization
Organization Name:MARTIN WOUND CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SYDNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MACC
Authorized Official - Phone:256-505-6826
Mailing Address - Street 1:5903 SPRING CIR
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-2811
Mailing Address - Country:US
Mailing Address - Phone:256-505-6826
Mailing Address - Fax:256-571-2862
Practice Address - Street 1:11491 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0136
Practice Address - Country:US
Practice Address - Phone:256-505-6826
Practice Address - Fax:256-571-2862
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-20
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL2796OtherGROUP MEDICARE NUMBER
AL238173Medicaid