Provider Demographics
NPI:1669450847
Name:EDMONDS, MARTA J (MD)
Entity Type:Individual
Prefix:
First Name:MARTA
Middle Name:J
Last Name:EDMONDS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:209 NE 10 RD
Mailing Address - Street 2:PO BOX 1816
Mailing Address - City:GREAT BEND
Mailing Address - State:KS
Mailing Address - Zip Code:67530-8818
Mailing Address - Country:US
Mailing Address - Phone:620-792-4121
Mailing Address - Fax:
Practice Address - Street 1:1021 EISENHOWER AVE
Practice Address - Street 2:GREAT BEND CHILDREN'S CLINIC, P.A.
Practice Address - City:GREAT BEND
Practice Address - State:KS
Practice Address - Zip Code:67530-3213
Practice Address - Country:US
Practice Address - Phone:620-792-5437
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0423536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS045811OtherBLUE CROSS BLUE SHIELD KS
KS100127410AMedicaid
KSE89986Medicare UPIN
KS100127410AMedicaid