Provider Demographics
NPI:1659384006
Name:MOBIL MARTIN, INC.
Entity Type:Organization
Organization Name:MOBIL MARTIN, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:O
Authorized Official - Last Name:VIRSIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:216-281-7777
Mailing Address - Street 1:14837 DETROIT AVE
Mailing Address - Street 2:BOX 123
Mailing Address - City:LAKEWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44107-3909
Mailing Address - Country:US
Mailing Address - Phone:216-281-9300
Mailing Address - Fax:216-281-8500
Practice Address - Street 1:1279 W 73RD ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44102-2060
Practice Address - Country:US
Practice Address - Phone:216-281-9300
Practice Address - Fax:216-281-8500
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH180322341600000X
OH185815343800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
No343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0856346Medicaid
OH2516405Medicaid
OH9341341Medicare ID - Type UnspecifiedMEDICARE